Experimental

The abstracts which follow have been classified for the convenience of the reader under the following headings: Experimental Studies; Animal Tumors Intrathoracic Tumors Biochemical Studies The Digestive Tract Etiological Theories The Pancreas General Clinical Observations The Liver Diagnosis and Treatment The Suprarenal Glands The Skin The Female Genital Tract The Eye The Genito-Urinary Tract The Ear The Nervous System The Breast The Bones, Joints and Tendon Sheaths The Oral Cavity and Upper Respiratory Hodgkin’s Disease, Lymphosarcoma, the Tract Leukemias, Reticulo-endotheliosis The Salivary Glands Education The Thyroid Gland Statistics AS with any such scheme of classification, overlapping has been unavoidable. Shall an article on ‘‘ Cutaneous Melanoma, an Histological Study ” be grouped with the articles on Histology or with the Skin Tumors? Shall Traumatic Cerebral Tumors go under Trauma or The Nervous System? The reader’s choice is likely to depend upon his personal interests; an editor may be governed by no such considerations. The attempt has been made, therefore, to put such articles in the group where they would seem most likely to be sought by the greatest number. It is hoped that this aim has not been entirely missed. As abstractors are never perfect, and as the opinions expressed may on occasion seem to an author not to represent adequately his position, opportunity is offered any such to submit his own views for publication. The JOURNAL will not only welcome correspondence of this nature but hopes in the future to have a large number of author abstracts, SO that the writer of a paper may present his subject in his own way. If readers of this JOURNAL wish to communicate with the writers of articles abstracted in its pages or to secure reprints, the editorial staff will be glad, so far as possible, to supply the addresses of these authors. Photostats of original articles will also be furnished, if desired, to be charged at cost.

572 ABSTRACTS

EXPERIMENTAL STUDIES; ANIMAL TUMORS

Pathological Changes Induced in the Mamma by Oestrogenic Compounds, HAROLD BURROWS. Brit. J. Surg. 23: 191-213, 1935. The regulation of the structure and function of the mamv by hormones has long

some substance derived from the placenta. for these opinions

no influence was exerted upon visceral metastases. Burrows applied 0.01 per cent solution of pure estrin, sqpplied by Dr. Andre Girard of Paris, to the interscapular region of mice twice a week. The earliest effect was proliferation of the mammary ducts. Small mammary cysts then foU\owed. After this a stage of hyperplasia ensued, comparable to the chronic cystic mastitis'-yf chronic cystic hyperplasia of the human breast. For this lesion Burrows suggests t e term " oestrogenic mastopathy." Following this, the equivalent of a benign adenoma in the human female may develop, and finally in a few mice of both sexes a carcinoma breast appears. Burrows quotes with approval Lacassagne's statement that\: occurrence of carcinoma depends upon the individual's responsiveness to estrin an&.. varies greatly among the different pure bred strains. He believes that if these studies can be confirmed, they point to a possible control for cancer of the breast in females. Further studies showed differences in the effects of various hormones. Estrin, for example, produced proliferation and dilatation of the ducts; equilin resulted in the formation of alveoli and had but little, if any, tendency to cause proliferation and dilatation of the ducts. Another estrogen, ketomethoxyestrin, has a capacity similar to estrin in the production of cystic disease of the breast and the same quality is found in several of the more complicated derivatives of 1 : 2 : 5 : 6-dibenzanthracene. A somewhat lesser effect is produced by dihydroxyestrin (dimenformon, Organon Lab.) and tri- hydroxyestrin (theelol, Parke, Davis & Co.) and equilenin prepared by Girard. Some 18 photomicrographs illustrate the lesions and a sufficieiit bibliography is appended.

Metaplasia of Uterine Epithelium Produced in Rats by Prolonged Administration of Oestrin, C. S. MCEUEN. Am. J. Cancer 27: 91-94, 1936. Squamous metaplasia of the uterine epithelium with downgrowth into the stroma was produced in castrate female rats by intra-uterine or continued subcutaneous injections of oestrone in oil but no metaplasia of the sex gland epithelium could be produced by this means in male rats. Metaplasia of the uterine epithelium did not follow direct application of 1 : 2 : 5 : 6- dibenzanthracene, nor of gas-house tar, nor of pregnandiol, although the two first- named are known to be carcinogenic.

Relation of the Sexual Hormone to Cancer, J. HOFBAUER.Zum Thema. Sexual- hormone und Vorstufen des Karzinoms, Zentralbl. f. Gynak. 59: 9-11, 1935. A decided proliferation of the epithelium can be secured in uncastrated animals following the injection of the growth hormone of the anterior pituitary gland. There 5 73 5 74 ABSTRACTS are also marked hyperemia and a varying degree of edema. These changes, the author believes, may at times be considered as forerunners of carcinoma [but obviously there is no pra?f of this]. There are no illustrations. BENJAMINR. SHORE

Effect of Sex Hormones on Transplanted Neoplasms, F. BISCHOFFAND L. C. MAXWELL. Am. J. Csncer 27: 87-90, 1936. Experiments are reported which extend and confirm the authors’ earlier observations that gonadotropic extracts and estrin do not influence the growth of transplanted tumors.

On the Relation between t&e Incidence of Mammary Cancer and the Nature of the Sexual Cycle in Various Strains of Mice. 11. The Relative Constancy of the Characteristics of the $exual Cycle in These Strains, V. SUNTZEFF,E. L. BURNS, MARIANMOSKOP AND LEO LOEB. Am. J. Cancer 26: 761-766, 1936. In a second study on thre relation of the estrous cycle to mammary cancer in mice (for the first see Am. J. Cancer 26: 56, 1936), the writers found that certain characters of the sexual cycle may remain more or less constant within a given strain of inbred animals but there is no correlatioa between these characters and the incidence of mammary cancer.

Experimental Productkin of Visceral Tumors with Hydrocarbons, FREDERICW. ILFELD. Am. J. Canozr’26: 743-753, 1936. The authw reports the production of 10 renal epidermoid carcinomas in mice and 2 in rat* following the implantation in the kidney of cholesterol pellets containing 1 : 2 : 5 : 6-dibenzanthracene. Methylcholanthrene similarly implanted in 3 amimals was without effect. The production of one fibrosarcoma by methylcholanthrene, pres)amably arising from the spleen, one uterine epidermoid carcinoma by dibenzanthra- cwie, and two tumors of the liver by dibenzanthracene, is also described. A number of photomicrographs are included. A bibliography is appended.

Production of Cancer by Hydrocarbons Other than Those of the Phenanthrene Type, AVERYA. MORTON,CHARLES F. BRANCHAND DANIELB. CLAPP. Am. J. Cancer 26: 754-760, 1936. The authors were able to produce cancer in mice by injections of triphenylbenzene and by painting with tetraphenylmethane, thus proving that neither a condensed ring system of four or five rings nor a phenanthrene nucleus is an essential feature of a carcinogenic hydrocarbon. [This had already been shown by the production of liver tumors with orthn-amido-azotoluol.]

Note on the Preparation of Dispersions of Carcinogenic Hydrocarbons in Serum, EGONLORENZ AND H. B. ANDERVONT.Am. J. Cancer 26: 783-786, 1936. The authors describe the preparation of solutions of the carcinogenic hydrocarbons 1 : 2 : 5 : 6-dibenzanthracene and methylcholanthrene in serum alone and serum saturated with cholesterol. A table shows the concentration of the hydrocarbons in the various sera used.

Production of Hepatoma in the Mouse by Feeding with o-Amido-Azotoluol, YASVO NISHIYAMA. Experimentelle Hepatombildung durch Fiitterung init o-Amidoazo- toluol bei der Maus, Gann 29: 285-294, 1935. The annular cirrhosis of the liver which develops in rabbits after the administration of o-amido-azotoluol, but occurs only exceptionally in the rat [Yoshida: Gann 29: 213, 1935. Abst. in Am. J. Cancer 26: 790, 1936. See, also, following abstract] is encountered with fair frequency, though in less typical form, in the mouse, which in this respect thus occupies a position between rabbit and rat. Of 46 mice, only 7 survived eleven months’ feeding with about one-third the rat- dose of this drug; 6 among these 7 had multiple hepatomas of the liver entirely similar EXPERIMENTAL STUDIES ; ANIMAL TUMORS 575

to those which arise in the rat, and one had, in addition, a hemangio-endothelioma in the liver and the lung. In the absence of definite proof, however, the author prefers to suspend judgment as to the malignancy of these hepatomas, notwithstanding their histological resemblance to the demonstrably malignant corresponding neoplasm of the rat. No instance of duct carcinoma was encountered. The paper is profusely illustrated with photographs of gross specimens and with photomicrographs. WM. H. WOGLOM

A Case of Annular Hepatic Cirrhosis in a Rat Fed with o-Amido-Azotoluol, TOMIZO YOSHIDA. Uber einen Fall der annularen Leberzirrhose der Ratte, welcher beim o-Amidoazotoluol-versuch beobachtet wurde, Gann 29: 302-305, 1935. As hepatic cirrhosis was not encountered among 600 rats fed with o-amido-azotoluol for the purpose of eliciting hepatoma and, in fact, had never been observed in the rat at all so far as the author’s experience goes, it must be difficu!t to produce with o-amido- azotoluol and, at the same time, extremely rare as a spontaneous disease. The author now describes an instance of annular cirrhosis discovered on the thirty- fourth day in one out of 7 rats fed with o-amido-azotoluol and subcutaneously injected twice weekly with 1.5 gm. of glucose in 30 per cent watery solution. A few of the parenchymal islets had the definite structure of hepatoma or, in other words, had undergone carcinomatous change. Among the remaining animals, % -developed hepatoma without cirrhosis, as is usual when o-amido-azotoluol is administered alone, after 240 and 250 days respectively. As the rabbit readily develops annular cirrhosis in consequence of ingesting o-amido- azotoluol, and the rat practically never, this case is of interest whether spontanFous or produced by the experimental procedure. The paper is accompanied by 3 photomicrographs and a photograph of the gross specimen. WM. H. WOGLOM

Incidental Vesical Tumors in Rats with Hepatoma Produced by o-Amido-Azotoluol, TOMIZOYOSHIDA. Uber die nebensachlich beobachteten Harnblasenepitheliome der mit o-Amidoazotoluol gefutterten Hepatomratten, Gann 29: 295-301, 1935. During the routine examination of a large series of rats that had been fed with o-amido-azotoluol for the purpose of eliciting hepatoma, there were encountered a number of vesical papillomas large enough to be evident even upon gross examination. Interesting though this discovery was at the time, it had to be neglected for the moment because the tumors were, after all, relatively uncommon. Once examination of the livers had been completed, however, a systematic search of the urinary bladders of these 378 animals was undertaken, with the result that microscopic evidence of epithelial proliferation was discovered in 30, while in 36 there were found macroscopic papillomas, one of which had been transformed into an infiltrating squamous-cell carcinoma. No parasites were ever found either in or about the tumors. The early changes were always discovered in rats that had been fed for 106 days or more, whether the drug had been then stopped or further continued, and became pro- gressively more striking as the period of administration reached 200-300 days. The first macroscopic papilloma occurred on the 151st day. No such lesions were encountered in 40 control animals or in 201 that died or were killed before the 100th day of feeding. Thus the papillomas may safely be referred either to the drug or to the products of its dissociation within the body. As they were by no means of such regular occurrence as hepatoma, some sort of local predisposition would appear to play an important r6le in their etiology. Yet on the whole the most advanced papillomas were found in rats with definite hepatomas. The article is illustrated by 15 photomicrographs and a photograph of a gross specimen. WM. H. WOGLOM 5 76 ABSTRACTS

The Fate of o-Amido-Azotoluol in the Animal Body, TOKUJIHASHIMOTO. uber den Abbau von o-Amidoazotoluol im Tierkorper, Gann 29: 306-309, 1935. The carcinogenic agent o-amido-azotoluol is partly reduced in the rabbit’s body to p-toluylenediamin and excreted in the urine as diacetyl bodies. WM. H. WOGLOM InvestigL on the Physico-chemical Properties of Normal and Pathological Tissues. Part 20. Effect of Various Agents on the Development of Tar Cancer, F. VL~S,A. DE COULONAND A. IJco. Recherches sur les propri6tCs physicochimiques des tissus en relation avec I’Ctat normal ou pathologique de I’organisme. 20” partie. Iliverses actions sur le cancer du goudron, Arch. de physique biol. 12: 138-154, 1935. Certain substances (stovarsol, pilocarpine) were found to retard the development of tar cancer in mice, while others (acetone extract of egg yolk, chloroform or benzol extracts of tar) accelerated it somewhat. LVM. H. WOCLOM Investigations on the Physico-chemical Properties of Normal and Pathological Tissues. Part 21. Influence of Darkness and Light on the Development of Tar Cancer. F. VL~S,A. DE COULONAND A. UGO. Recherches sur les propriCt6s physicochimiques des tissus eil relation avec l’ktat normal ou pathologique de l’organisme. 21” partie. Influence de I’obscuritb et de la lumiere sur la canchisation par le goudron, Arch. de physique biol. 12: 255-277, 1935. In contrast to Seelig and Cooper [Abst. in Am. J. Cancer 19: 412, 19331, the authors find that tar cancers develop more readily in mice kept in the light than in those kept in the dark. WM.H. WOGLOM Significance of the Number of Cells for the Inoculation of Adenocarcinoma in the Mouse, GERHARDWITTE. Bedeutung der Zellzahl bei der Verimpfung des Adeno- carcinoms der Maus, Deutsche Ztschr. f. Chir. 245: 251-255, 1935. In the past few years the transfer of neoplasms by means of blood or metastasis- free organs from tumor-bearers has been repeatedly described, and the question of an extracellular etiological agent has arisen once more in consequence. Such observations cannot he reconciled with the rather general belief that successful subcutaneous inoculation requires a minimum of from 100,000 to 1,000,000 cells. The author confirms this belief after having inoculated 80 mice with saline suspensions of the Ehrlich mouse carcinoma. A dose of less than a million cells hardly ever gave rise to a tumor. Above this figure the number of positive inoculations and the growth rate of the resulting neoplasms increased more or less in proportion with the dose until an optimum was reached at 12,000,000, beyond which no augmentation was possible. It has been said that conditions in the subcutaneous tissues are not especially suitable and that many of the inoculated cells perish there on account of the relatively poor blood supply, only a small group of survivors eventually giving rise to the tumor. In any case, a very few will suffice to produce a metastasis in the parenchymatous organs, where conditions are more favorable. The demonstrable relation between inoculation outcome and number of cells injected is so incompatible with the assertion that tumors can be produced by the inoculation of metastasis-free organs as to indicate the necessity for further investigation, since the whole question of an extracellular etiologic agent, a “ neoplasmatase,” is here involved. Something might perhaps be learned by an inquiry, such as is now in progress, into the fate of the individual tumor cell, as distinguished from the graft, immediately after it has been inoculated or deposited in an internal organ. WM. H. WOGLOM

Reaction of Mice and of Various Mouse Tumors to the Injection of Bacterial Products, H. B. ANDERVONT. Am. J. Cancer 27: 77-83, 1936. Bacterial filtrates prepared from B. coli and the meningococcus bacillus were found to be more toxic for both normal and tumor-bearing mice when the injected animals were kept at a temperature of 37” C. Skin tumors proved to be valuable test objects for the activity of the filtrates, the earliest reaction being demonstrable about two hours after injection. Representatives of four lines of pure strain mice inoculated EXPERIMENTAL STUDIES ; ANIMAL TUMORS 5 77 cutaneously with sarcoma 37 and sarcoma 180 showed varying response to injections of the bacterial filtrates, emphasizing the importance of the strain of tumor-bearing animal used in such investigations. Filtrates of B. coZi failed to produce hemorrhage in practically all spontaneous mammary gland carcinomas of mice as well as in the first transplants of such tumors. Hemorrhage was produced with regularity in primary 1 : 2 : 5 : 6-dibenzanthracene tumors and in some instances brought about complete retrogression of the first transplants of such tumors.

Effect of the Shwartzman Reaction with Bacterial Filtrate on Transplantable Tumors in Animals, MENDELJACOBI. Am. J. Cancer 26: 770-774, 1936. Jacobi was able to demonstrate the Shwartzman phenomenon in mouse sarcoma 180, Flexner-Jobling rat carcinoma, Walker rat carcinosarcoma 256, and Rous chicken sarcoma. The tumor tissue was prepared or sensitized by bacterial filtrate (B. typhosus), following which intraperitoneal or intravenous injection of the same filtrate produced in the tumor tissue a violent hemorrhagic and necrotic reaction, succeeded either by a complete sloughing and healing or by slow recurrence of the tumor growth, which again responded to filtrate injections. The author appends a note in which he states that an attempt was made to duplicate these findings in a patient with an inoperable recurrence of t.arcinoma of the breast. The patient died four days later, at which time the tumor was completely necrotic. [For abstracts of papers by others, describing this reaction in fmrs, see Am. J. Cancer 16: abst. p. 521, 1932; 19: 102, 1933; 20: 650, 885, 1934; 25: 422,562, 1935.1

Experimental Basis of Prophylactic Radiotherapy of Malignant Tumors, B. GRYNKRAUT. Bases experimentales de la radiothkrapie prophylactique des tumeurs malignes, J. de radiol. et d’klectrol. 18: 583-584, 1934. The growth of Jensen rat sarcoma, inoculated into animals which have previously been strongly irradiated, is much retarded, but metastasis is more frequent than in the non-irradiated controls. This failure of the tumor to grow rapidly is due to impaired nutrition, brought about by edema of the endothelium in the arterioles in the irradiated area. But since the lymphatic system is not injured, metastases can occur in other parts of the body, particularly in the ganglia. [The phenomenon of increased metastasis following palliative irradiation has been observed in human patients, the checking of the tumor growth giving time for unusual and extensive metastasis to take place, while if untreated the patient would die before metastasis occurred.] CHARLESPACKAKD

Attempt to Develop Reduced Radio-sensitivity in Jensen Rat Sarcoma by Means of Roentgen Irradiation, BJORN SNELLMAN.Acta Radiol. 16: 545-556, 1935. It is common clinical experience that a malignant tumor may become less and less sensitive to radiotherapy as time goes on, but the cause of this increased resistance is not well understood. Reasons have been advanced by previous investigators for referring it to the sclerosis, and consequent poor nutrition and reduced metabolism, which radiation sets up in the surrounding normal tissues. However, radiosensitivity may be ascribed also to certain inherent properties of the tumor cell itself, in theory at least, and in the present investigation the author has tried to find out whether these properties can be altered by irradiation. It appeared possible to do so, as others have said, for when the Jensen rat sarcoma was irradiated in vivo with sublethal roentgen doses and then transplanted, most of the resulting tumors were less radiosensitive. This reduced sensitivity was accompanied by slower growth, a higher collagen content, and a smaller number of mitotic figures. [This result is not observed when the Crocker Fund sarcoma 180 is repeatedly rayed and transplanted.] WM. H. WOGLOM 5 78 ABSTRACTS

Biologic Study of the Action of X-rays on Malignant Tumors Especially on the Attitude of the Stromal Tissues of Malignant Tumors to X-rays. Part V. Attitude of the Blood Vessels to X-ray Irradiation (l), H. KAWAKAMI.Jap. J. Obst. & Gynec. 18: 152-183, 1935. X-rays inhibited the growth of the Kato rabbit sarcoma by disturbing the metabolism of its stroma. The article is illustrated by 41 photomicrographs and roentgenograms. WM. H. WOGLOM

Effect of Roentgen Rays on the Colloid State and Amino-acid Content of Rat Sarcoma, P. SZENDR~,E. SCHI-EICHER AND I,. KLUGE. Wirkung von Rontgenstrahlen auf Kolloidzustand und Aminosauregehalt von Rattensarkomen, Biochem. Ztschr. 276: 331-335, 1935. The authors gave doses of 500 roentgens to one of each pair of simultaneously implanted, ten- to fourteen-day-old rat sarcomas, the unirradiated tumor on the opposite side of the same animal serving as control. Twenty-four to seventy-two hours after irradiation they removed and analyzed the tumors. The tyrosine, cystine, and trypto- phane content of the tumors,and the total nitrogen and isoelectric points of the different albumen fractions, were determined. No significant differences between the normal and irradiated tumors were observed. H. Q. WOODARD

Action of Ultra-short Waves on Transplantable Mouse Cancer, P. MERCIERAND G. JOYET. Action du champ Clectrique de tr&shaute frequence (ondes ultra-courtes) sur la croissance des greffes de cancer CpithClial chez la Souris, Bull. Soc. Vaudoise de sc. nat. 58: 377-382, 1935. A transplantable mouse carcinoma (obtained from Caspari) was distinctly inhibited by one hour’s exposure daily to ultra-short waves (4.6 meters). Such severe treatment was tolerated only when the cages were so ventilated that the body temperature of the mice rose less than 2 degrees. Microscopic examination showed no difference between treated and control tumors. [No reference is made to the many preceding investigations in this field. Those who have carried out such experiments include Schereschewsky: Pub. Health Reports 43: 927, 1928; Schereschewsky and Andervont: ibid. p. 940; J. R. Ross: Am. J. Cancer 18: 905, 1933; Ludwig and von Ries: Ztschr. f. Krebsforsch. 40: 117, 1933 (Abst. in Am. J. Cancer 21: 116, 1934); Reiter: Deutsch. med. Wchnschr. 59: 1497, 1933 (Am. J. Cancer 21: 871, 1934); A. E. Roffo: NCoplasmes 12: 129, 1933 (Am. J. Cancer 20: 650,1934);Haas and Lob: Strahlentherapie 50: 345, 1934 (Am. J. Cancer 22: 693, 1934); HaschC and Collier: Strahlentherapie 51: 309, 1934 (Am. J. Cancer 25: 166, 1935); L. Hill: Brit. M. J. 2: 370, 1934 (Am. J. Cancer 24: 672, 1935). Three opinions have been expressed: (1) Short waves have no effect on tumors; (2) short waves have a specific inhibiting effect; (3) short waves have an inhibiting effect which is not specific, but merely a result of heat.] WM. H. WOGLOM

Vitamin A and Carcinogenesis, B. SURE,K. S. BUCHANANAND H. S. THATCHER.Am. J. Cancer 27: 84-86, 1936. Massive doses of vitamin A to the extent of 3000 times the maintenance require- ments were found to have no influence on tumor inhibition or tumor regression of Walker rat carcinosarcoma No. 256.

Effect of Cod-Liver Oil on Tumor Growth, FRANCESL. HAVEN. Am. J. Cancer 27: 95-98, 1936. The rate of growth of transplantable rat carcinosarcoma 256 was less in mice on a cod-liver oil diet than in those receiving coconut oil, though the growth of the host animals was essentially the same. The authors suggest that the long chain C20 and C22 acids abundant in cod-liver oil may exert an inhibitory effect on tumor growth. EXPERIMENTAL STUDIES ; ANIMAL TUMORS 5 79

Effect of Insulin Therapy on Transplantable Tumors in Mice, H. PINKERTON,S. M. BEALE,S. WARREN,AND A. KIELING. Am. J. Cancer 27: 99-103, 1936. The administration of insulin supplemented with parathormone or splenotrat exerted no beneficial effect on the course of transplantable mammary gland adenocarcinoma in the mouse.

Influence of Age on the Growth of Sarcoma 180, FRITZBISCHOFF AND M. LOUISALONG. Am. J. Cancer 27: 104-105, 1936. In three inoculation series comprising 90 mice of the Marsh Buffalo strain, sarcoma 180 grew significantly to greater size in young (20 gm.) mice than in old (30 gm.) mice.

Storage of Magnesium Compounds in Tumors, F. EICHHOLTZAND KAUDERER.Ablager- ung von Magnesiumverbindungen im Tumor, Biochem. Ztschr. 276: 326-330, 1935. The authors made subcutaneous injections of calcium chloride, magnesium chloride, magnesium sulphate, and magnesium pyrocatecholsulfate into rats bearing multiple transplanted sarcomas. The tumors were removed for analysis at different times after the injections. Magnesium chloride and sulphate were takZn up by the tumors at the same speed, but magnesium pyrocatechol sulphate was not absorbed. The magnesium salts were taken up in smaller amounts and more slowly than the corresponding calcium salts. The sensitivity of the tumors to 2.50 roentgen doses of roentgen rays was not influenced by previous subcutaneous injection of magnesium salts but was increased by calcium salts. Sensitization reached its maximum fifteen minutes after injection, while the maximum absorption of calcium by the tumor did not occur until two hours after injection. The sensitizing effect of the calcium must therefore have been indirect. H. Q. WOODARD

Lipolytic Activity of the Organs of Normal and Tumor-bearing Animals, S. EDLBACHER AND M. NEBER. fher das Lipasespaltungsvermogen der Saugerorgane im gesunden und tumorkranken Organismus, Ztschr. f. physiol. Chem. 233: 265-27.5, 1935. The authors studied the lipolytic activity on tributyrin of various rat and guinea-pig organ and tumor extracts by the method of Rona. The activity of liver was much greater than that of brain. The activity of the extracts was the same in an atmosphere of oxygen or nitrogen as in air. The influence of atoxyl and quinine on the lipolytic activity of rat liver or brain was different from that on human organ extracts. The activity of tumor or necrotic tissue was of the same order of magnitude as that of brain. The activity of the liver, brain, and blood of tumor-bearing animals was much less than that of the corresponding tissues of normal animals. H. Q. WOODARD

On Chemotherapy in Leucosis of Fowls, J. ENGELBRETH-HOLM,A. ROTHE MEYER, AND E. UHL. Acta path. & microbiol. Scandinav. 12: 491-510, 1935. Repeating some experiments reported by others, the authors found that Rhodoquine (a quinine derivative) had some slight beneficial effect in fowl leukosis but that Plas- mochin (another quinine derivative) and R 237 (a lead preparation) were entirely inert. WM. H. WOGLOM

Precipitation Tests in Mice. Preliminary Report: I. Cancer. 11. Comparative Study of Cancer-susceptible and Immune Mice, LEONELLC. STRONGAND TYRRELLH. WERNER. Am. J. Cancer 26: 767-769, 1936. The writers describe a precipitation test which they employed on the blood of cancer- susceptible and immune mice. Mice of the cancer-susceptible A strain showed a gradual diminution of the precipitate with advancing age, from 50 to 550 days. Mice of the cancer-resistant CBA strain, on the other hand, showed an increasing amount of precipitate between 150 and 450 days. 5 80 ABSTRACTS

Precipitation Tests in Mice. 111. A Disturbance between Two Hundred and Three Hundred Days of Life. IV. Determinations on Mice Belonging to an Immune-to- Cancer Stock, CBA, LEONELLC. STRONG. Am. J, Cancer 27: 115-119, 1936. A continuation of the precipitation tests described in an earlier paper (Abst. above) showed a disturbance in mice of the high-cancer A strain in the mechanism or mechan- isms that control the final precipitate reading, between the ages of 201 and 300 days of life. Mice of the strain under consideration go through a period of depression, as measured by the mortality curve, coinciding closely with this disturbance and thereafter develop carcinoma of the breast with increasing frequency. The author asks whether, there may not be some relation between the precipitation disturbance and the eventual development of cancer. The precipitation test in mice of the CBA strain, a low-cancer strain, failed to show the disturbance observed in the A strain. Other differences in response to the test were also observed between the two strains.

Maintenance of Human Normal Cells and Tumor Cells in Continuous Culture. 1. Pre- liminary Report: Cultivation of Mesoblastic Tumors and Normal Tissue and Note8 on Methods of Cultivation, G. 0. GEY AND MARGARETK. GEY. Am. J. Cancer 27: 45-76, 1936. The authors have been able to maintain in continuous culture normal human fibro- blasts and a number of different types of human tumor cells for long periods of time. They describe in detail their methods, media, and technic, and include photomicrographs of stained sections and cultures.. A bibliography is appended. Primary Adenocarcinoma of the Liver in a Rooster, JACK C. NORKIS.Am. J. Cancer 26: 778-780, 1936. Report of a case illustrated by a photograph and 2 photomicrographs.

Metastasizing Hepatoma in a Hog (Sus scrofa), WILLIAMH. FELDMAN.Am. J. Cancer 27: 111-114, 1936. In a collection of 110 neoplasms of swine 2 tumors were observed which arose from the parenchymal cells of the liver. One of the tumors was benign and remained localized. The other tumor, which is described in detail, was of an aggressive and malignant character. It consisted of several nodules in the liver and multiple metastatic foci in the lungs. Three photomicrographs are included.

Parasitic Tumor in a Gilthead, HERVB HARANTAND PAULETTEVEKNI~RES. lJn nouveau cas de tumeur parasitaire chez la Daurade, Arch, SOC.d. sc. mCd. et biol. de Montpellier, 16: 367-368, 1935. Report of a trematode granuloma in the fish known as gilthead. WM. H. WOGLOM

I3 1OCH EMI CAI, STUDI ES

The Glycolytic Co-ferment of Tumors, H. KKAUTAND R. LV. NEFFLEN. uber das Co-Ferment der Clykolyse aus Tumoren. 111, Ztschr. f. physiol. Chem. 232: 270-279, 1935, The authors made extracts of the gray matter of beef brain and fractionated the extracts in various ways in order to obtain pure and highly potent preparations of co-ferment T. The properties of the various fractions are described and compared with those of pyroracemic acid, which has the same glycolysis-activating action as CO- ferment ‘r. H. Q. WOODARD ETIOLOGICAL THEORIES 581

Lactic Acid Formation in Unirradiated and Irradiated Tumor Tissue, W. HAARMANN. aber die Milchsabrebildung in unbestrahltem und bestrahltem Tumorgewebe, Biochem. Ztschr. 280: 113-183, 1935. The authors determined the ability of various human tissues to form lactic acid from glucose, glycogen, hexosediphosphate, and pyroracemic acid. They consider that the tumor metabolism bears more resemblance to that of brain than to that of any other normal tissue, that the lactic acid production of tumor tissue is inhibited more by irradiation than is that of normal tissue, and more in tumors which do not recur than in those that do. The nature and amount of radiation employed is not stated. H. Q. WOODARD

Serum Globulin and Albumin. VII. The Tyrosine and Cystine Content of the Albumen Fraction of Ascitic Fluid from Cases of Cirrhosis, Sarcoma, and Carcinoma, B. LUSTIGAND E. MANDLER.Zur Kenntnis der Globuline und Albumine des Serums. VI I. Der Tyrosin- und Cystingehalt der Eiweisskijrperunterfraktionen von Cirrhose-, Sarkom-, und Carcinompunktionsflussigkeiten, Biochem. Ztschr. 278: 312-319, 1935. Fluids from one case of cardiac ascites, 2 cases of cirrhosis, 3 of carcinoma, and one of sarcoma, were examined. The proteins were separated jnto water-soluble, NaCl- soluble, and h’azCO3-soluble euglobulin and pseudoglobulin fractions, and three albumin fractions. No significant differences in the tyrosine content of corresponding fractions of the different fluids were found. There were slight differences in the cystine content. H. Q. WOODARD

On Tumor Antigens, F. BREINLAND E. CHKOBOK.Zur Kenntnis der Tumorantigene, Ztschr. f. Immunitgtsforsch. 11. exper. Therap. 86: 274-284, 1935. Alcoholic extracts of human carcinoma were purified by adsorption on animal charcoal and elution with hot benzol. The tumor-specific substance was found to be nitrogen free and to be neither a phosphatid nor a carbohydrate. Active fractions contain cholesterol esters; inactive fractions do not. Hydrolysis with acids or alkalis destroys the activity of the extract. Shaking the eluate with weak acids or alkalis in the cold does not affect the activity. The extract will take up bromine with loss of activity. H. Q. WOODARD

ETIOLOGICAL THEORIES

Etiology and Heredity in Cancer, 0. KOEHLER. Die Frage der Verursachung des Krebses im Lichte der Erbforschung, Deutsche med. Wchnschr. 61: 1791-1796,1935. The author reviews the recent work on heredity in neoplasia and reaches the conclusion that certain mouse cancers have been definitely proved to be, and all other malignant growths probably are, somatic mutations. WM. H. WOGLOM

Regeneration, Super-regeneration and Cancer, HERMANNSTAHR. Vom Machtbereich der Regeneration (Superregeneration und Krebs), Acta Cancrol. 1 : 553-562, 1935. Neoplasia and super-regeneration are but exaggerations of a reparative process- regeneration. WM. H. WOGLOM

Lipoid Metabolism and Neoplastic Growth, P. RONDONI. Metabolisme lipidique et croissance neoplasique, Acta Cancrol. 1 : 593-604, 1935. The author discusses the presumption of a relationship between lipoid and protein metabolism in malignant disease. WM. H. WOGLOM

Question of Etiological Relationship between Cancer and Molds, WERNER-HERBERT RASCHER. Die Frage ursachlicher Beziehungen zwischen Krebs und Schimmel. Inaugural Diss., Albert-Ludwigs-Universitat, Freiburg i. Br., 1935. This monograph does not attempt to prove an etiological relationship between molds and cancer but merely suggests that the possibility of such a connection should be considered. WM. H. WOGLOM 5 82 ABSTRACTS

GENERAL CLINICAL OBSERVATIONS

One Hundred Cases of Sarcoma, L. DELREZ,P. VAN P~E,P. DESAIVE,AND P. DUMONT. Considerations 2 propos de 100 cas de sarcomes, Rev. belge sc. med. 7: 1-9, 1935. A clinical review is given of 100 cases of sarcoma of various types observed at the anti-cancer center of the University of Li&ge. The incidence was 2.4 per cent of all the cancers seen over a ten-year period. The average age was forty-two years. In 5 cases a tumor had been present for a long time before diagnosis; 8 patients gave a history of trauma preceding the appearance of the tumor. The distribution of these growths was not unusual, Twenty-seven cases appeared cured, with a follow-up of seven months to eight years. Of these, 2 were melanosarcoma, 5 osteogenic sarcoma, 4 were of myelogenous origin, 3 were chondrosarcoma, 10 sarcoma of the soft tissue, and 3 lymphosarcoma. There is no mention of the follow-up in the individual case. A combination of radiation and surgery seemed to offer the best therapeutic results, but treatment varies with the type of tumor. The authors believe that trauma has some relationship to the appearance of sarcoma. Their bone sarcomas are classified according to Kolodny. They advocate liiopsy whenever possible. No photographs are included. A short bibliography is appended. CHARLESA. WALTMAN

Cutaneous Glomus and Its Tumors-Glomangiomas, 0. T. BAILEY. Am. J. Path. 11: 9 1 5-936, 1935. The cutaneous glomus is an arteriovenous anastomosis in the stratum reticulare of the cutis, which is homologous with the glomus coccygeum and several less important vascular structures. These have in common a specialized glomus cell which is a modified smooth muscle cell with abundant nervous connections. Tumors arising from the cutaneous glomus form a sub-group of hemangiomas for which the term glomangioma is suggested. Glomangiomas appear as small, reddish or bluish nodules on the extremities or adjacent portions of the shoulder girdle. Very frequently they are located in the nail bed. Microscopically the tumors are composed of cells identical with those in the walls of the normal cutaneous glomus and its homologues. Nerve trunks are numerous in the connective tissue about the tumors, and nerve filaments pass among the glomus cells in large numbers. Occasionally elongate smooth muscle cells are seen either in solid masses or adjacent to vascular lumens. The glomangiomas represent the overgrowth of the entire arteriovenous anastomosis and their cells show a two-fold differentiation. The elongated smooth muscle cells lose all myofibrils, while the reticulum investing them becomes much coarser and stains intensely with collagen stains. Secondly, the periglomic nerves grow into the tumors and their terminal filaments end about the differentiating smooth muscle cells with the interposition of nerve endings. These two processes result in the formation of the glomus cells and are apparently interdependent. Glomangiomas represent functionally and morphologically organoid overgrowths. They are not malignant, and a local excision gives complete and permanent relief from symptoms. The article is illustrated with a photograph and several photomicrographs. BENJAMINR. SHORE

Glomus Tumors (Arterial Angioneuromyoma of Masson), D. LEWIS AND C. F. GE- SCHICKTER. J. A. M. A. 105: 775-778, 1935. The authors report 17 cases of glomus tumors. Clinically the most striking characteristic of these growths is pain, spontaneous and provoked. Pain of such severity is not found in neuromas. The tumors usually are smaller than neuromas and are not situated on a large peripheral nerve. They occur most frequently in the nail bed and about the fingers and toes. They are by no means limited to these areas, however, for in 13 of the 17 cases reported, the lesions were in other locations, such as the elbow, knee, leg, and palm of the hand. The article is illustrated with five photomicrographs. BENJAMINR. SHORE GENERAL CLINICAL OBSERVATIONS 583

Glomus Tumors. A Brief Clinical Study of the Glomus Angio-Myo-Neurome Artgriel of Barre and Masson, M. S. BURMANAND A. M. GOLD. New York State J. Med. 35: 618-620, 1935. A small, bluish, subcutaneous tumor located on an extremity and attacks of ex- cruciating pain on contact are the salient diagnostic features of glomus tumors. Simple excision of these growths completely relieves the patient and results in a cure. The histories of two glomus tumors are included. There are no illustrations. BENJAMINR. SHORE

Frequency of Cancer in Young People, B~GOUIN.FrCquence du cancer chez’les jeunes, Gaz. hebd. d. sc. mCd. de Bordeaux 56: 488-489, 491, 1935. The author reports that 5 of the 30 patients with cancer of the digestive tract on whom he has operated in the last thirteen years were less than thirty-five years of age. Twenty-nine of 294 patients treated for cancer of the cervix were also less than thirty- five. In neither series is the total number of cases for the hospital given. There is no bibliography. CHARLESA. WALTMAN

Syphilis and Cancer in the United States, A. TOURAINE. Syphilis et cancer aux lhats-Unis, Bull. SOC.franc. de dermat. et syph. 42: 649-653, 1935. The author has drawn his figures principally from the works of Petersen (Arch. Dermat. & Syph. 30: 425, 1934, abst. in Am. J. Cancer 24: 696, 1935), Haustein (in Jadassohn’s Handbuch f. Haut. u. Geschlechtskr. XXII, pp. 571-583,718-736,763-766, 808-813), and Lawrence (reference not given), and has tried to find a relationship between the incidence of syphilis and skin cancer by states and regions in America. In general he concludes that both diseases are more prevalent in areas of dense population, easy communication, and great industrial or agricultural activity. THEODOREP. EBERHARD

Chondroma and Trauma, M. CHIFOLIAU,M. DUVOIR,AND F. LAYANI. Chondrome et traumatisme, Ann. de mCd. 1Cg. 15: 701-708, 1935. A patient at the age of seventeen years received a severe trauma of the upper thigh. A large hematoma developed and some claudication was observed afterwards. Eight years later a tumor was discovered in this region, but it was not until eighteen years after the original injury that the tumor was demonstrated as an osteochondroma. A general discussion of the relationship of trauma to the etiology of chondromas is given, and it is concluded that traumatism to a chondroma may aggravate the tumor, even provoking a malignant change. It is not impossible for traumatism to a growing epiphysis to engender the formation of a chondroma but no actual etiological relationship has been demonstrated. An x-ray photograph and a photomicrograph are included. Three references to the French literature are given. CHARLES A. WALTMAN

Post-traumatic Cholesteatoma, G. DIDIER. Un cas de cholestCatome occipito-temporal post-traumatique, Ann. d’oto-laryng., pp. 1298-1304, December 1935. A patient received a severe blow back of the right mastoid. Two months later pus was evacuated from this region, and five years after this a cholesteatoma was removed from the area. The tumor extended to the dura, but no connection with the ear was demonstrable. No malignancy was described. Two x-ray photographs and one photomicrograph illustrate the report. There is a bibliography. CHARLESA. WALTMAN 5 84 ABSTRACTS

DIAGNOSIS AND TREATMENT

Setology of Tumors, F. BREINL, V. KINDERMANN,AND E. CHROBOK. Beitrag zur Serologie der Tumoren, Ztschr. f. Immunitiitsforsch. u. exper. Therap. 86: 260-274, 1935. The serological properties of 10 human carcinomas and a human sarcoma were examined and were compared with those of various organs. There was considerable similarity in the properties of the various carcinoma extracts. In some cases tumor- specific substances were found in metastasis-free organs from the cancerous individual, as well as in the tumor substance. H. Q. WOODARD

Precipitating Power of Cancer Serum, M. L. CHEVREL-BODIN,F. CHEVREL,AND M. CORMIER. Etude sur le pouvoir floculant du skrum des cancereux, Ann. Inst. Pasteur 55: 108-123, 1935. This article contains the jame material as that appearing in Compt. rend. SOC.de biol. 118: 520, 1935 (Abst. in Am. J. Cancer 24: 867, 1935).

Application of Ascoli's Serological Test for Malignant Tumors, E. PONZI. Applicazione delle prove serologiche di M. Ascoli per i tumori maligni, Ateneo parmense 6: 595-599, 1934. Ponzi has carried out Ascoli's serological test for cancer on a series of 75 patients and concludes that further study is warranted. Seventeen of his patients had malignant tumors of various types; except for 5 that had been receiving radiation treatment the test was positive in all. In 2 patients with uterine myomas the test was negative. It was positive, however, in 4 patients operated upon for various non-neoplastic conditions. The test was also carried out on 12 pregnant women and 6 women in the puerperium. The reaction was partly positive in 11 of these. In 34 controls, patients with various non-neoplastic gynecological lesions which had not been operated upon, 6 positive reactions were obtained. The test includes two separate reactions: (1) the ability of a saturated solution of bilirubin in ether to take up blood serum, and (2) the ability of ricinic acid to displace the unsaturated fatty acids in blood serum. C. D. HAACENSEN

VBlez Hematological Index in Normal Subjects and Cancer Patients, J. SABRAZ~S,J. BIDEAU,AND J. P. GLAUNES. Recerche du signe hCmatologique de VClez chez des sujets normaux et chez des cancbreux, Gaz. hebd. d. sc. mCd. de Bordeaux 56: 467-469, 515-523, 1935. The method of determining the VClez leukocyte index is described in Gaz. hebd. d. sc. mbd. de Bordeaux 56: 305-313, 1935. In active tuberculosis the value is higher than + 10, sometimes reaching + 55. In 32 normal subjects all the values were minus or normal. Of 16 patients with non-malignant tumors and diseases other than cancer, 7 gave values in excess of + 10. One patient included in this supposedly non-malignant group had metastases to the liver, and the index for this case was zero. Of 6 patients with lymphogranulomatosis, 3 gave positive and 3 negative values. Among 46 cases of treated cancer plus values were obtained in 54 per cent. Of 21 cases of cancer without treatment, 8 gave minus values, in 4 the index was zero, and in 9 it was between + 1 and + 10. Of 33 cases described as partly treated, 7 gave a negative index, 7 a positive less than 10, and 19 a positive greater than 10. The author concludes that the VClez index is of some diagnostic value in cancer, though it is evident that other diseases also give positive values. A bibliography is appended. CHARLESA. WALTMAN

Treatment of Cancer Patients. Study of End Results in 351 Autopsied Cases, IRAI. KAPLAN. New York State J. Med. 36: 303-316, 1936. This is a study of the autopsy records of 351 patients from the New York City Cancer Institute. A large number of facts are tabulated under the different anatomical divisions in which the material in the paper is arranged, but the number of cases is too DIAGNOSIS AND TREATMENT 585 small to be of value from a statistical aspect and nothing new is brought out. There are many dogmatic statements in the paper which the material does not warrant. For example, under cancer of the tongue the fact that there was only one case out of twelve in a negro is cited as evidence that the disease is infrequent in the colored race. As a matter of fact, it is not so infrequent as this statement would suggest. Again, under cancer of the breast the statement is made, on the basis of 38 cases, that “ radical breast surgery alone is not the method offering the best opportunity for curing this condition.” Apparently Dr. Kaplan believes that preoperative and postoperative x-ray therapy actually prevent or inhibit bone metastasis. There is no evidence of this from the material which he has studied and very little evidence in the published literature. Nor is his statement that, “ notwithstanding the admitted superiority of irradiation over surgical procedures for cancer of the cervix, quite a number of patients are still being treated by hysterectomy,” as valid a criticism as it appears. Some of the leading European surgeons are still doing surgery on operable cases of cancer of the cervix with excellent results. One interesting fact is that in five patients, in spite of careful autopsy search, no primary lesion was found to account for the metastatic ‘I malignancy ” present. Four had a tumor mass in the neck and one had a tumor in the iliac fossa. The fact that in 1.4 of the group of patients dying of malignant disease the prixhary source of the lesion cannot be determined is very important. The general conclusions drawn are as follows: “ Malignancy in any location is con- trolled only when recognized and diagnosed early and when complete, adequate and intensive treatment is carried out at once. . . . “ Irradiation is of little benefit in the treatment of advanced malignancy. Bone malignancy was little affected by irradiation, nor was cancer of the lung responsive to this form of therapy. . . . “ Malignancy may metastasize anywhere and the primary lesion is not always limited to the area visible or palpable. Irradiation treatment for cancer must cover the whole body and those areas most likely to become involved by extension and metastasis.” [This last statement means nothing because it is quite impossible to radiate the entire body with an effective dose in any patient no matter how long he or she may be willing to submit to treatment, and no one can tell which areas are most likely to become involved by extension and metastasis. In reality all that can be done is to ray such lesions as cause severe symptoms and leave the rest alone in order to conserve the patient’s strength.]

Roentgen Ray Investigations on Carcinoma. First Report: Cytologic Studies on Human Carcinoma, P. SEULBERGER,W. SCHMIDT,AND F. KRONING. Rontgenbiologische Untersuchungen an Carcinomen. I. Mitteilung. Cytologische Studien an ober- flachlichen und tiefgreifenden menschlichen Carcinomen, Strahlentherapie 31: 467-494, 1929. Second Report: Cytology and Histology of Tumors after Repeated Irradiation, P. SEULBERGER,W. SCHMIDT,AND F. KRONING. 11. Mitteilung. Cytologie und Histologie des Tumoren nach mehrfacher Bestrahlung, Strahlentherapie 34: 247-272, 1929. Third Report : Fractional Distant and Close Roentgen Therapy, P. SEULBERGER. 111. Mitteilung. Erfahrungen mit fraktionierter Fern- und fraktionierter Nahbe- strahlung, Beitr. z. klin. Chir. 162: 534-544, 1935. The authors’ original studies were made upon some 25 cases of human carcinoma which were exposed to varying doses of x-ray, from 80 to 180 per cent of a skin dose, following which biopsies were taken at different periods, the tissues were carefully fixed, and details of the cell changes studied. [Unfortunately the dosage is not given in r units, so that it is impossible to repeat the authors’ work exactly.] The general conclusions reached were as follows. (1) The number and type of mitoses before radiation are different in the different tumors. (2) Each tumor reacted to the radiation with a quantitative and qualitative alteration in the karyokinetic figures. (3) The time of the reaction is variable. (4) Resting cells in the tumors undergo changes in which the nuclei break up into more or less fine granules and drops of chro- 5 86 ABSTRACTS matin. (5) In many tumor cells it was possible to observe after radiation processes suggesting solution of the cell structures, which perhaps are due to increased fermenta- tive action. (6) After radiation an increased round-cell infiltration and connective- tissue proliferation could be observed in the tumors and the surrounding tissues, which the authors regard as a reaction of the organism to the radiation. They further conclude that there is no possibility of a comparison between the effect of radiation on normal tissue and that on a neoplasm. They do not believe that the different types of tumors have any fixed dose or that there is, for example, a carcinoma or sarcoma dose. [The paper adds little to our present knowledge of the morphological changes in the cells in the mitotic or the resting phase, and the photomicrographic illustrations are not very satisfactory. A good bibliography is appended.] In the second study, instead of the radiation being given in a single high dose, as in the first instance, smaller repeated doses were used, amounting to from 20 to 50 per cent of a skin erythema does, so that ultimately between 100 and 180 per cent of a skin erythema dose was given in divided doses. Fifteen cases of human cancer were studied. Repeated biopsies were made during the course of irradiation and afterwards. The authors again point out that a given dose gives different results in different tumors. In the cases treated the results were rarely satisfactory [which is to be expected from the small doses given]. Fifty' per cent of a skin erythema, given once a week, is certainly not an effective way of producing any result on a highly malignant neoplasm. In fact, the authors record that some of the tumors became absolutely refractory to further radiation. They doubt that by morphological studies alone any great advances will be made in the problem of the proper division of the " radiation period and quantity " for x-rays. The few photomicrographs given do not add to our knowledge of the cytological changes in the tumors after radiation. In the third paper, by Seulberger alone, he attempts a study of four cases in which the Coutard method of radiation was used and six others treated by the Chaoul technic, in which the tube is practically in contact with the growth and runs at about 60 kv. A daily dose of 50 r was given, by the Coutard method, and [as might be expected] practically no effect was obtained on the tumors. The description of the patients treated with the Chaoul technic shows good primary healing, but the patients were not observed in any instance more than a few months. The doses given were sometimes as high as 9000 r, in two sittings. An anal carcinoma was treated with 14,000 r, and two months later, as the tumor had not disappeared, 5200 r was given in eleven sittings. The tumor appeared to be completely destroyed, but biopsies two months later showed ample carcinoma tissue in the deeper structures. The author concludes in general that with the Chaoul type of radiation the penetration is very limited. In the conclusions Seulberger makes a number of generalizations which have long since been shown to be incorrect. He then discusses the danger of the production of mutations in the tissues by x-rays, drawing the conclusion that because mutations have been produced in Drosophila by radiation, they will also be produced in the cells of the skin by exposure to roentgen rays. [He forgets apparently that in one case thegonadsare being rayed and in the other the skin. Obviously radiation may produce mutations in the cells of the skin, but these mutations are in most instances not capable of survival, and it is only when radiation has been excessive and ulceration or other serious damage has been produced so that a continuous reactive process is going on that an x-ray cancer may appear. The author also seems to forget that with the literally millions of people who have been rayed with x-rays very few have died of cancer produced by that agent; certainly a generous estimate would be 500 persons including all the x-ray operators who have developed x-ray cancer.] He concludes that in superficial carcinoma the Chaoul technic should be used. Where the growths are apt to be deep, higher voltages can be used both for relatively small and large neoplasms. The Coutard type of radiation with prolonged and fractionated doses should be reserved for those patients in whom no result has been obtained by the other technic. [The reader will see from this that the paper is an unimportant one.] DIAGNOSIS AND TREATMENT 587

Radium Treatment in Cancer, R. W. RAVEN. Post-Grad. M. J. 11: 70-76, 1935. Raven discusses the treatment of carcinoma of the breast, tongue, and cervix uteri by surgery as compared with radium. He quotes the statistics of Gask (Proc. Roy. SOC. Med. 27: 69, 1933. Abst. in Am. J. Cancer 21: 497, 1934) showing a 65.4 per cent three- year cure rate for radical surgery of carcinoma of the breast without axillary node involvement and compares this figure with that published by the National Radium Com- mission (London, 1934) of 64 per cent for similar cases, 39.9 per cent for cases with node metastases, and 24.9 per cent for inoperable cases, all treated by radium alone. Surgery of cancer of the tongue gives a three-year cure rate of 28 per cent to 36 per cent. The report of the Radium Commission gives a three-year survival rate in favorable cases of 40 per cent. If, however, the disease has spread to the nodes the rate drops to 12.9 per cent. These statistics were compiled from a total of 322 cases. Bonney’i five-year cure rate in surgically treated carcinoma of the cervix is quoted as 25.5 per cent. This figure is compared with the following figures for three-year survival rates given by the Radium Commission: 60.8 per cent for early carcinoma, 48.1 per cent for carcinoma with involvement of one or more fornices, 32.6 per cent for carcinoma with parametrial involvement, and 11.8 per cent when there is massive infiltration of both parametria. All stages grouped together gave a three-year cure rate of 39.4 per cent. [This figure can be obtained only by omitting advanced cases. When all those who apply for treatment are included the five-year cure rate falls to about 23 per cent with radium and much less with surgery.] GRAYH. TWOMBLY

Recent Developments in the Technic of Radiotherapy of Cancer, F. PERUSSIA.Nuovi orientamenti della tecnica nella radioterapia del cancro, Nuntius radiol. 3 : 3-32, 1935. This is a general survey of the developments which have taken place in radiotherapy during the past three or four years. Perussia discusses in particular the achievements with very high-voltage roentgen rays, and declares himself a partisan of this type of treatment. A bibliography is included. C. D. HAAGENSEN

Radiation from a Tube of Small Dimensions, E. FUHRERAND H. SCHON.Neue Moglich- keiten der Strahlentherapie durch ein einfuhrbares Rontgenrohr, Wien. med. Wchnschr. 84: 972-973, 1934. In the early period of therapy with x-rays, unfiltered radiation was used successfully, notably by Dr. William A. Pusey of Chicago, for the treatment of epithelioma of the lip. These early treatments were given, obviously, at low voltages. In recent years the tendency has been to use high filtrations and higher voltages. Of late Chaoul has developed a convenient mechanical construction which permits of the radiation of inaccessible, small carcinomata of the oral cavity and of the cervix with soft, unfiltered radiation produced at about 90 kv., and a considerable interest has been excited as to the final results. The risk of the employment of such unfiltered radiation lies chiefly in the limited penetration of the areas, so that tissues one or two centimeters from the tube may receive an insufficient dose while the surface of the neoplasm may be destroyed. In the cervix, for example, while the neoplasm in contact with the tube may be eradicated, the parametrium obviously receives no radiation, and therefore the primary contact treatment with a Chaoul apparatus must be supplemented by high-voltage radiation. The authors of this paper have gone further by devising an x-ray tube which can run at about 70 kv. and can be held in the hand of the physician while the treatment is administered, since the whole tube measures only about 30 mm. in diameter. They suggest that such a tube could be used for the treatment of carcinoma of the uterus, larynx, esophagus, and rectum. [Since the foundations of highly filtered radiation therapy are fairly well established and have been reached only after years of experimental study, it would seem wise to limit the use of these special forms of apparatus, by which large doses of very soft x-rays can be applied to the tissues, to a few clinics with sufficient material and facilities for observation, so that a prompt report can be made on a considerable number of patients and the ultimate results evaluated as quickly as possible. The probability is that their usefulness is extremely limited and their employment should be wholly in the hands of expert and highly experienced radiotherapists. 588 ABSTRACTS

The widespread use of such radiation should be discouraged until its advantages have been proved.]

Biological Measurements of Radium Gamma Rays, F. M. EXNERAND C. PACKARD. Radiology 25: 391-402, 1935. The biological measurement of gamma rays consists in determining the doses in milligram element hours which, under specified conditions, produce in Drosophila eggs the same quantitative effect as definite doses of x-rays measured in roentgens by a standard chamber. The ratio thus obtained is expressed in " biological roentgens." In these experiments the applicator consists of a spherical filter of 0.5 mm. platinum, enclosing at its center a small glass bulb of radon. Surrounding the filter is a shell of bakelite, 4.7 mm. thick, whose outer surface is 1 cm. from the radon bulb, which may be considered as a point source. Slips of filter paper bearing the eggs are laid on'this surface, and removed after definite doses have been given. The criterion of effect is the percentage of survival. This is compared with the survival rate of eggs which have received measured doses of x-rays. The latter data are derived from a series of 200 experiments. A dose of 190 r results in a survival rate of 50 per cent f 3.10. Thus if 50 per cent survive a dose of gamma rays, that dose is equal to 190 biological roentgens. In order to avoid the effect of rays scattered from nearby objects, the applicator was suspended at a distance from walls, furniture, etc. Secondary beta radiation from the air was avoided by surrounding-the applicator with a shell of bakelite 3.5 mm. thick. Any secondary beta radiation which might affect the eggs was therefore produced in this region. Tests showed that their effect was slight. The results of these experiments indicate that under the conditions described 1 milligram element hour = 5.0 biological roentgens. This value is lower than those obtained by physical methods, which average 8 r/mg.el.hr. It is reasonable to take the view that the processes which determine the response of the eggs to gamma rays are more nearly representative of the biological processes involved in therapy than is the production of ionization through the wall effect of small thimble chambers. CHARLESPACKARD

On the Measurement of Radium Dosage, H. s. SouTTAn. Lancet 1: 255-257, 1935. The successful use of radium in therapy depends on accurate dosage accurately defined. The term milligram-hours is meaningless without a statement of the distribution of the source, distance and the filtration. The author proposes as a " natural " unit of measurement, the G, which is the gamma radiation from 1 mg. of element at 1 cm. from the source. The filtration is expressed by a suffix, G(1), G(2), etc., corresponding to platinum screens of 1 or 2 mm. Uniform distribution of intensity is obtained by arranging the needles in two concentric rings, 1 mg. at the center, 4 in the inner circle, and 16 in the outer, or in about that proportion if larger amounts are used. The number of G units required for different cases can be calculated from prepared tables, one of which is given. With this geometrical arrangement of needles, the intensity at a depth is inversely proportional to the distance from the source, and not to the square of the distance. [The author is apparently unaware of the work of Marie (J. Cancer Research 11: 377, 1927) and others in this field.] CHARLESPACKARD

Roentgen Dermatitis Following Coutard Therapy Treated by Padutin, A. WOLTEH. Rontgen (epi)dermatitis bullosa als Folgeerscheinung der Methode nach Coutard und deren Beeinflussung durch Padutin, Rontgenpraxis 7: 473-476, 1935. The histories of two patients are reported in which bullous dermatitis following roentgen irradiation by the Coutard technic was treated by '' padutin," a proprietary pancreatic preparation. This was injected intramuscularly daily for sixteen days. Four photographs illustrate the article. BENJAMINR. SHORE

Medical Treatment of Cancer, R. ROOSEN. Ziel und Aussichten medikamentoser Krebsbehandlung, Acta med. Scandinav. 85: 499-504, 1935. The author believes that cell division in cancer may be prevented by the employment of astringents, though it is difficult to find an astringent which is not poisonous and THE SKIN which will cause a permanent or irreversible action. A brief discussion of such astringents as lead, bismuth, tannic acid, isamin blue, and aluminum salts is included. A short bibliography is added. CHARLESA. WALTMAN

Eflect on Tumors of Intravenous Injections of Soluble Compounds in Which Iron is Associated with Vitamin C, F. ARLOINC;,A. MORELAND A. JOSSERAND. Action sur les tumeurs, en injections intraveineuses, de produits chimiques solubles dans lesquels le fer est associC b la vitamine C (acid ascorbique), Compt. rend. Acad. d. sc. 201: 456-458, 1935. The authors made intravenous injections of various dyes combined with ascorbic acid and ferrous and ferric chlorides. They observed occasional regressions of rabbit testicular tumors, and retardation of growth and improvement in general condition in some human cancers of the tongue, tonsil, stomach, and uterus. Severe edema in the neighborhood of the tumor was often produced. H. Q. WOODARD

Chlorophyll Treatment of the Asthenia of Cancer, R. DUPONT. Traitement de l’asthenie canckreuse par la chlorophylle, Bull. mCd. 49: 117-118, 1935. Sodium chlorophyllate given in doses up to 10 cg. intravenously promotes a sense of well-being in patients with cancer. There are no harmful effects. One case is briefly described. No animal experiments are mentioned. The source of the chlorophyll is not divulged. There is no bibliography. [See also Abst. in Am. J. Cancer 24: 874, 1935.1 CHARLESA. WALTMAN

Tissue Extracts in the Treatment of Cancer, H. SEARLEBAKER. Lancet 2: 583-584, 1935. In a letter to the Lancet the writer again sets forth his theory that cancer arises through failure of an inhibitory factor presumably secreted by the connective tissue and discharged into the lymph stream (see Abst. in Am. J. Cancer 21: 404, 1934). On the basis of this theory he has devised a method of treatment with tissue extracts, in combination with iodine, with which he claims to have obtained benefit.

Immuno-biological Prophylaxis of Cancer, A. BKAUNSTEIN.Sur la prophylaxie immuno-biologique du cancer, Rev. belge sc. mCd. 7: 240-254, 1935.

This article contains a general review of the author’s experiments with “ Splendo- thelan,” a spleen extract. For accounts of these see Berl. klin. Wchnschr. 48: 2029, 1911; Ztschr. f. Krebsforsch. 24: 325, 1927; 32: 119, 1930; 39: 321, 1933, and Med. Welt 7: 1286, 1933. The later papers are abstracted in Am. J. Cancer 15: 369, 1931 and 19: 857, 1933. CHARLESA. WALTMAN

’THE SKIN

Carcinoma, Precancerous Conditions and Benign Epithelioma of the Skin, J. DOERFFEL. Karzinome, Priikanzerosen und gutarige Epitheliome der Haut (Klinik, Histologie und Genese), Med. Klin. 31: 1436-1440, 1935. For the most part this article is a general description of the clinical and histological appearances of various types of neoplasms of the skin. A case of Paget’s disease of the vulva is briefly described, and one of syringoma with cystic sweat gland arrangement is mentioned. Two cases described as nevus syringo-cystadenomatosus papilliferus showed histologically a basal-cell epithelioma and a cystic sweat-gland tumor. There are no photomicrographs, and no bibliography is included. CHARLESA. WALTMAN

Melanomas, D. H. AFFLECK. Am. J. Cancer 27: 120-138, 1936. This is a generously illustrated discussion of pigmented nevi and malignant melanoma based on more than 500 cases from the Surgical Pathological Laboratory of Johns Hopkins Hospital. A bibliography is included. 5 90 ABSTRACTS

Prognosis of Simple Moles and Melanotic Sarcoma, SAMPSONHANDLEY. 1,ancet 1: 140 1-1402, 1935. The author devotes this paper to four questions. The first has to do with the risk that a congenital mole may become malignant. The chances against this are regarded as at least some thousands to one. The second question concerns the factors favoring malignancy in moles. These are chronic irritation, more rarely a single acute trauma, and unwise irritant treatment, as by caustics, carbon dioxide snow, or partial excision. The other two questions have to do with melanotic sarcoma-the outlook in untreated cases and the chances of cure. The average duration the author places at about three years. The disease spreads chiefly by way of the lymphatics, and node involvement is an early feature. Blood dissemination is a late event and for this reason adequate excision in the early stages should produce a cure. The author briefly describes the essential steps for the removal intact of the permeated area of the lymphatic system, of the invaded nodes, and of the trunk lymphatics connecting these. He has treated only 8 or 10 operable cases and in most of these the growth was recurrent following earlier treatment. One of his patients lived eighteen years, another was well three and a half years after treatment, when she was lost sight of, and a third patient was well at the time of the report [how long after operation is not stated].

Prognosis of Simple Moles and Melanotic Sarcoma, E. S. HORGAN. Lancet 2: 156, 1935. This letter from Khartoum, commenting on Sampson Handley’s paper on simple moles and melanotic sarcoma (abst. above), contains some interesting figures on the incidence of melanomas in the Sudanese. Of 438 malignant tumors examined in the pears 1930-35, 31 or approximately 7 per cent were melanomas. Eighteen of these were from the foot. A similar high incidence is recorded among the Nigerians, 10 melanomas, all of the foot, occurring among 90 malignant neoplasms seen in 1930-33. These figures are in direct contradiction of the view generally accepted that melanoma is a rare tumor in the dark-skinned races.

A Verrucous-Like Pigmented Basal-cell Epithelioma Originating in a Nevus, J. PEYRI. Epith6lioma baso-cellulaire pigment6 B forme verruqueuse et A point de depart naevique, Bull. SOC.franc. dermat. et syph. 42: 945-948, 1935. A fifty-three-year-old man had had many black verrucous lesions on the back, face, and thigh for about fifteen years. One of these began to grow and invade the skin and was excised. Histologically it appeared to be a basal-cell epithelioma with large de- posits of pigment. The nature of the pigment is not stated. The origin seemed to be in a seborrheic wart, although M. Civatte points out that this type of nevus does not become cancerous. THEODOREP. EBEHHAKD

Nevus-Carcinoma of the Heel, J. NICOLAS,G. MASSIA,J. KOUSSETAND G. CHANIAL. Naevo-carcinome du talon, Bull. Soc. frans. dermat. et syph. 41: 706-707, 1935. This is a report of an ulcerated lesion of two years’ duration on the left heel of a man forty years old. Large inguinal masses were present. Biopsy is said to have showed a melanocarcinoma. No histologic description is given. The report is without illustrations or bibliography. THEODOREP. EBERHAHD

Malignant Melanomatosis, F. BURNSPLEWES. Am. J. Cancer 26: 732-737, 1936. Plewes reports a case of malignant melanomatosis in a man of thirty-eight, involving the pelvic bones, spine, ribs, and skull, the large veins and serous surfaces, and lymph nodes. Autopsy failed to reveal the primary site. The first symptoms were referable to the sacro-iliac joint and the largest tumor was found in that region. The literature on melanomatosis is reviewed with special reference to the site of the primary lesion and details of four cases are included in tabular form. A photomicrograph illustrates the report, and a bibliography is appended. THE SKIN 591

Free Melanin-Bearing Cells in Ascitic Fluid in Diffuse Melanomatosis, W. R. SNOD- GRASS. Lancet 2: 668, 1935. A woman of fifty-three had a pigmented mole removed from the left hip. Two years later she suffered from malaise, discomfort after meals, and vomiting. The abdomen was greatly distended and large amounts of ascitic fluid were repeatedly removed. After the first few paracenteses the fluid was found to contain free melanin- bearing cells, and bluish-black melanotic tumors developed in the needle tracks. The amount of melanin in the fluid was greatly increased by palpation of the abdomen. Autopsy revealed numerous melanotic tumors in the omentum and peritoneum and pigmented lesions in the stomach and small bowel. The heart, lungs, kidney, liver, and spleen were not involved.

Closure of Defects Following Extirpation of Malignant Cutaneous Melanomas, E. ORBACH. Zur Frage der Defektdeckung nach Exstirpation b6sartiger Melanome der Haut, Wen. med. Wchnschr. 85: 1112-1113, 1935. The author believes that local recurrences are more commonly seen following the Thiersch grafting of defects resulting from radical extirpation of malignant cutaneous melanomas than after closure of these defects by pedicle grafts. It is believed that a local and generalized tendency towards the formation of melanoblastomas present in these patients is increased and a zone of " local anaphylaxis " is set up by the transplantation of skin from one area of the body to the other. There are no illustrations. BENJAMINR. SHORE

Pigmented Epitheliomas of the Skin, A. TOURAINE. I.es Cpithdiomas pigment& de la peau, Ann. de dermat. et syph. 6: 785-811, 1935. The author has made a clinical analysis of pigmented epitheliomas not arising from nevi. He has collected 42 cases from the literature and 13 from the moulages in the museum of the hospital with which he is connected. Most of these are basal-cell epitheliomas and there is an extensive discussion as to the significance of the pigment. On this point pathological studies of P. Masson (Ann. d' anat. path. 3: 417 and 657, 1926) and B. Bloch (in Jadassohn's Handbuch f. Haut u. Geschlechtskr., 1927, l/l, pp. 434-541) are quoted. Three of the moulages are reproduced as photographs. A good bibliography is appended. CHARLESA. WALTMAN

Pigmented Basal-cell Epitheliomas, A. TOURAINEAND P. RENAULT. EpithCliomas baso-cellulaires pigment&, Bull. SOC.fraq, dermat. et syph. 42: 644-649, 1935. This is a report of two cases of pigmented basal-cell epithelioma. The first occurred on the chin of an eighty-two-year-old woman. It had been present for about fifteen months, was 1 cm. in diameter, firm, dark, violet-brown in color, ulcerated, tender, 'and bled easily. The second was also in a woman, aged fifty-four years, in the right malar region; it was the size of a small bean, black, with intact overlying skin. Both patients had other keratoses and pigmented spots. There were no metastases. Histologically both lesions were typical basal-cell carcinomata with the additional factor of pigmented chromatophores between the cords of tumor cells. These pigment- bearing cells occurred almost entirely at the periphery of the tumor, particularly between the tumor and the skin, which itself showed much pigment in the basal layers. Attention is called to the similarity in appearance between this type of tumor, nielanocarcinomata, and lupus erythematosus. There is a short bibliography but no illustrations are included. THEODOREP. EBERHARD

Bloch's Benign Melano-epithelioma, R. CASAZZA.uber das Blochsche benigne Melanoepitheliom, Arch. f. Dermat. u. Syph. 173: 61-74, 1935. Bloch has identified a type of benign pigmented tumor of the skin which is presumed to arise from the dendritic cells of the epidermis, rather than from nevus cells. Casazza describes a tumor of this type which he observed in a man aged thirty-seven. During the war he was burned on the buttock by an exploding shell. In 1918, a darkly pig- 592 ABSTRACTS niented area appeared in the scar of the burn, and slowly increased in size. The pigmented area finally became ulcerated. It was then removed surgically. Histologically it showed irregular thickening of the epidermis, within which there were thiti-walled, fluid-containing cysts. The individual epithelial cells had the general characteristics of basal cells. They formed irregular masses or strands which sometimes penetrated deep into the corium. The growth contained much pigment and also many dendritic cells. A photograph of the gross specimen, five photomicrographs, and a bibliography are included. C. D. HAACENSEN

Carcinomas Arising from Sweat Glands, F. FLARER.Considbrations histogbnbtiques et cliniques sur les itpithbliomes cutanbs de ditrivation glandulaire sudoripare, Ann. de dermat. et syph. 6: 1071-1106, 1935. Four cases are reported. In one of these, probably a case of Paget’s disease, the tumor arose in the areola. In the other three cases the tumor was on the face. The histologic picture was that of epithelioma of the sweat gland type, but in addition the overlying epithelial layer showed malignant changes. There is an extensive discussion of the problem of the two types of epithelioma, such as are found in Paget’s disease. Fifteen photomicrographs are included. A brief bibliography is appended. CHARLESA. WALTMAN

Surgery in the Treatment of Primary Skin Carcinoma, H. T. SIMMONS. J>ancet2: 938- 940, 1935. Simmons believes that the frequent recurrence of skin cancer following operation is due to failure on the part of the surgeon to observe the recognized principles of surgery in malignant disease. From his observation of recurrent cases he concludes that the usual elliptical incision is inadequate, trespassing on the margin of safety. Better treatment is obtained if the matter of repair is regarded as a distinct problem and is not allowed to affect the extent of the operative removal.

Electrosurgical Treatment of Skin Cancers, M. DUCOURTIOUX.Le traitement blectro- chirurgical des cancers de la peau et des muqueuses orificielles, Ann. de dermat. et syph. 6: 118-136, 1935. Photographs of fifteen patients before and after treatment by electrosurgery for lesions of the skin or lips are shown in the text. The only description of the cases is contained in a few lines with each photograph. According to the author, when the diagnosis is evident, no biopsy is taken, and there are no biopsy reports in this article. Recurrences have been rare, but the length of follow-up is not mentioned except for one case, in which it was eighteen months. There is no statement as to whether the nodes were involved. The technic of electrosurgery is described at length. There is no bibliography. CHARLESA. WALTMAN

Large Epithelioma of the Face, J. GAT&AND P. DUGOIS. Epithblioma gbant de la face, Bull. SOC.franG. dermat. et syph. 42: 364-365, 1935. This is a brief report of a patient with a histologically proved prickle-cell epithelioma covering the left eye, part of the cheek, and half of the forehead. The growth started ten years before on the eyelid and grew slowly and steadily. Biopsy showed it to be well differentiated. A photograph of the patient is included. THEODOREP. EBERHARD

Sudoriparous Prickle-cell Epithelioma of the Nose Following a Single Injury, MARQUES. Epithblioma spino-cellulaire sudoripare du nez conskcutif A un traumatisme unique, Bull. SOC.frany. dermat. et syph. 42: 814-818, 1935. Although single injuries are recognized by many authors as the cause of certain sarcomas, there is great scepticism about carcinomas ever arising in this fashion. Some deny the possibility, saying the lesion already present had escaped the patient’s atten- THE SKIN 593 tion; some believe the injury happened to come when a lesion would have developed anyway; and a few admit that a single trauma may be important. The author presents a case of a sixty-three-year-old man who had never been to a doctor except for a slight injury to the nose and forehead following a fall six years before. These abrasions healed within two weeks and left no scars. Thirteen months before treatment, the patient again fell and suffered minor abrasions of the forehead and a deep laceration of the nose. The former healed promptly, but the nasal wounds continued to drain purulent material and to form crusts in spite of treatment. Serologic tests for syphilis were negative. Finally a biopsy was done which proved the diagnosis of carcinoma. Some palpable submaxillary nodes were excised but proved to be only tuberculous. A photograph of the lesion and a photomicrograph of the biopsy section are included. There is no bibliography. THEODOREP. EBERHARD

Basal-cell Epithelioma Having Diverse Objective Aspects: Pearly Border, Cicatricial Base, Rodent Ulcer, J. NICOLAS,G. MASSIA,J. ROUSSETAND G. CHANIAL. Epithb- lioma baso-cellulaire ayant divers aspects objectifs: bordure perlke, plan cicatriciel, ulcus rodens, Bull. SOC.fraq. dermat. et syph. 42: 707-709, 1935. A brief report of an ulcerated lesion behind the left ear of a forty-four-year-old man. The lesion had been present for about three years, was painless, had a basically cicatricial appearance, but also a pearly border and a central ulceration. A biopsy showed basal-cell epithelioma. There is a photograph of the lesion, but no photomicrograph. THEODOREP. EBERHARD

Superficial Basal-cell Epithelioma with Multiple Localizations (Pagetoid Epithelioma), WEISSENBACH,L~VY-FRANCKEL, CAILLIAU, MARTINEAU, AND BROCARD. EpithC- lioma baso-cellulaire superficiel B localisations multiples (epithelioma pagCtoide). Evolution ulckro-vCgetante de deux elements, Bull. SOC.franc. dermat. et syph. 42: 931-934, 1935. A man seventy-five years old had four lesions on the anterior thoracic wall. Some were scaling and crusted, while others were ulcerated and presented cauliflower-like proliferations. Histologically they were basal-cell epithelioma. There is a discussion by MM. Civatte and Cailliau. Reference is made to Rousset’s Les dysktratinisations tpithtliomateuses, Masson et Cie, Paris, 1931. There are no illustrations. THEODOREP. EBERHARD

Neoplasm of the Face with a Pseudo-Actinomycotic Appearance, A. LUMIBRE,J. GAT& P. J. MICHELAND P. DUGOIS. NCoplasme du visage B forme pseudo-actinomycosi- que, Bull. SOC.franc. dermat. et syph. 42: 366-369, 1935. A man of sixty-four had what appeared to be a tumor of the lower lip and chin. It had started about three years before as a small papillomatous lesion at the left labial commissure. A biopsy showed only epithelial hyperplasia and a marked inflammatory reaction, and this finding, coupled with the presence of fissures and sinuses from which pus escaped, gave rise to a tentative diagnosis of actinomycosis. Intensive treatment with potassium iodide had no effect. Several more biopsies showed the same lesion as the first. The patient was subjected to many kinds of treatment for about eighteen months but did not improve. The Wassermann reaction was negative. Death was due to pneumonia, and at autopsy tissue from the depths of the mass showed epithelioma. In a short discussion by MM. Favre and Nicolas the point is stressed that biopsies must be taken from the base of the lesion, and that when the biopsy does not agree with a clinically reasonable diagnosis the former must give way to the latter. THEODOREP. EBERHARD

Cutaneous Angio-epitheliomatosis, A. NANTAAND SALVADOR.Angio-Cpithkliomatose cutanCe, Bull. SOC.franG. dermat. et syph. 42: 653-657, 1935. This is a confusing report of a woman who developed over a period of two or three years what appeared to be diffuse angiomatous involvement of the skin of both breasts and the surrounding area from the umbilicus to the left scapular region. The left nipple 594 ABSTRACTS was retracted, indurated, oozing, and infected. A biopsy is described as showing large dilatations of the capillaries around and into which were growing masses of epithelial cells. Eventually the patient was found to have a massive carcinomatous infiltration of the lung. No decision about the diagnosis can be reached from the description. A photograph of the patient is given but there are no photomicrographs. THEODOREP. EBERHARD

Cutaneous Metastases of a Uterine Carcinoma, MILIANAND CHAPIREAU. MCtastases cutanCes d'un Cpithdioma utbrin, Bull. SOC.franc. dermat. et syph. 42: 943, 1935. A woman seventy-one years old had two tumors, one on the scalp and one on the right hip. She had been treated with intra-uterine radium a year before for bleeding (factors of radiation not given). A biopsy of the two skin tumors showed " cylindric epithelioma " interpreted by the authors as being of uterine origin. No details of the uterine pathology are given. There are no illustrations. THEODOREP. EBERHAKD

Two Cases of Mixed Tumors of the Face, J. MONTPELLIER. Deux cas de tumeurs mixtes du visage, Bull. Sac. franc. dermat. et syph. 42: 668-670, 1935. Two mixed tumors of the skin of the face are reported, one in the right nasolabial fold of a woman and the other in the left nasolabial fold of a man. The histological account of one of them describes briefly connective-tissue elements, myxomatous, fibrous, and cartilaginous tissue, and many epithelial formations, pseudo-malpighian, cubical, and microcystic. The other tumor was said to be the same. There is a brief discussion of the theories of histogenesis of these tumors. No illustrations are included. THEODOREP. EBERHARD

Mixed Tumor of the Cheek, I,. JAMEAND A. SOHIER.Tumeur mixte de la joue, Bull. SOC.franc. dermat. et syph. 42: 463-468, 1935. A man of forty-seven had a typical mixed salivary gland tumor in the subcutaneous tissue of the left cheek. A detailed histological account is given in which are described squarnous-cell elements, sudoriparous and sebaceous glands, cartilage, osteoid tissue, mucoid tissue, and true bone. In the discussion of pathogenesis the authors support the theory of the epithelial origin of these tumors with metaplasia as a result of histochemical reactions. The names of many writers upon the subject of mixed tumors are mentioned but no bibliography is given. There are no illustrations. THEODOREP. EBERHARD

Case of Sarcoma of the Thumb, FR. WORINGER,R. ZORNAND A. LABOURGADE.Un cas de sarcome du pouce, Bull. SOC.fraq. dermat. et syph. 42: 832-835, 1935. A man of twenty-six years had a lesion at the base of the right thumb which had appeared about five years before, apparently as an infection. This had been incised and excised several times, never remaining closed for more than two years. The lesion was localized and did not produce any obvious metastases. One biopsy was reported as spindle-cell sarcoma, but the authors disagree on the basis of the second biopsy, which they feel shows a " histiocytic " sarcoma, in spite of the lack of pleomorphism of the cells. A good histological description, a photograph of the gross lesion, and a photomicrograph of the section are included. THEODOREP. ERERHARD

Diffuse Metastatic Sarcomatosis of the Skin, A. SOZARY,A. HOROWITZAND P. BARDIN. Sarcomatose diffuse mbtastatique de la peau, Bull. SOC.franG. dermat. et syph. 42: 937-940, 1935. A woman thirty-nine years old had multiple skin nodules over the entire trunk and enlarged nodes in the cervical, submaxillary, and supraclavicular fossae. The original lesion had appeared in the right submaxillary space about three years before and had been treated with x-rays. It did not change, but no new masses appeared for nearly three years, when suddenly many lymph node and cutaneous masses appeared. These were treated by thoracic and abdominal irradiation, but did not respond, and the treatment had to be stopped because of the patient's condition. Two biopsies were done which showed sarcoma. At autopsy, about two weeks after admission, tumors similar THE SKIN 595

to the cutaneous nodules were found in the lungs, liver, and kidneys, but the peritoneum was not involved. Both ovaries were large and cystic and on section showed papillary masses projecting into the cysts, which microscopically resembled the other tumors. The authors are unable to determine the origin of this “ polymorphic-cell sarcoma.” They do not believe that it was ovarian in origin because of the lack of peritoneal implants. The factors of the x-ray treatment are not given, nor are there illustrations or references to other literature. THEODOREP. EBERHARD

Histology of Kaposi’s Disease, H. HOMMA. Zur Histologie der Kaposischen Krankheit, Centralbl. f. allg. Path. u. path. Anat. 63: 241-244, 1935. The author reports a case of Kaposi’s sarcoma in which the usual histologic picture was complicated by the presence of large numbers of giant cells, both of the foreign body and Langhans type. These cells were interpreted as indicating an inflammatory origin of Kaposi’s disease. Three photomicrographs illustrate the article. BENJAMINR. SHORE

Pseudotuberculoma Silicoticum, J. S. FAULDS.J. Path. & Bact. 41: 129-135, 1935. Two cases are reported of subcutaneous nodules presumably due to accidental implantation of siliceous material. Examination of the tissue by polarized light revealed the presence of optically active crystals. Though the structure in each instance was suggestive of tubercle formation, no tubercle bacilli were demonstrable. In each there was a history of injury many years before. A similar case has been reported by Shat- tock under the designation pseudotuberculoma silicoticum (Proc. Roy. SOC.Med. 10: Section on Pathology, page 6, 1916-17). The paper is illustrated by photomicrographs.

Solitary Dermatomyoma, H. DUBOUCHERAND J. MONTPELLIER. Dermatomyome solitaire, Bull. SOC.franc. dermat. et syph. 42: 797-799, 1935. A case is reported of one of the rarer solitary smooth-muscle tumors of the skin. It occurred in a female, fifty-two years of age, in the skin of the chest wall just below the inframammary fold. The presenting symptoms were itching and occasional pain. The tumor measured only 5 x 8 cm. An excellent histological description is given, but no photomicrographs are included. In the discussion, the authors comment particularly upon the marked variations in the differentiation of the smooth muscle fibers of the tumor and upon the relatively large amount of well differentiated connective tissue. There is no bibliography. THEODOREP. EBER~AEE?

A Small Ulcerated Chondroma of the Helix Simulating Clinically an Ulcerated Basal- cell Epithelioma, J. NICOLAS, G. MASSIA AND J. ROUSSET. Petit chondrome ulckrk de l’hklix simulant cliniquement un Cpithklioma baso-cellulaire ulcCrC, Bull. SOC.franc. dermat. et syph. 42: 688-690, 1935. This is a short report of a small ulceration on the helix of the right ear which was thought to be an ulcerated basal-cell epithelioma. It was excised and histologically proved to be a small chondroma which had grown to the surface and ulcerated the overlying skin. A photomicrograph is included, but no bibliography. THEODOREP. EBERHARD

Tumor of the Skin of Unknown Origin. Report of a Case, F. R. SCHMIDT.Arch. Dermat. & Syph. 32: 626-628, 1935. This is a brief report of a small tumor occurring in the subcutaneous tissue of the forearm of a girl of fifteen. It grew rapidly and did not respond to radiation. On excision it was found to possess the invasive characteristics of a malignant growth. A diagnosis of neurogenic sarcoma had been made, but Dr. Pierre Masson, to whom sections were submitted, thought it a leiomyoma because of the absence of the collagenous reticulum around the tumor cells and because of the acidophile staining quality of the cytoplasm. No general agreement upon the diagnosis was reached. Two photomicrographs are included. 596 ABSTRACTS

THE EYE

Bilateral Epithelioma of the Sclero-corneal Limbus, LOPES DE ANDRADE. Epitheliome bilateral du limbe sclCrocornCen, Ann. d’ocul. 172: 897-907, 1935. A twenty-year-old farmer had tumors on both eyes developing over a period of four years. A drawing shows these tumors at the limbus on both sides. There were no enlarged preauricular lymph nodes, and no ulceration was demonstrable by fluorescein. Histologically both tumors showed epithelial proliferation with mitoses and pearl formation. Five photomicrographs show the pathology distinctly. The patient was treated by simple extirpation of the tumor under a local anesthetic with treatment of the operative site by electrocautery. After eleven months there was no recurrence. A short bibliography is added. CHARLESA. WALTMAN

Angiomatous Cylindroma of the Internal Angle of the Eye, J. GAT& G. MASSIAAND P. J. MICHEL. Cylindrome angiomateux de l’angle interne de l’oeil, Bull. SOC. frany. dermat. et syph. 42: 379-380, 1935. The patient was first seen with a small lesion at the internal angle of the right eye, of two years’ duration. The biopsy report was cylindroma of Malassez, but the presence of considerable blood within many of the cavities of the tumor cause the authors to consider the tumor of angiomatous nature. One photomicrograph is included. THEODOREP. EBERHARD

Lindau’s Disease (Angiomatosis of the Central Nervous System and of the Retina), F. LOTMAR. Zur Kenntnis der Lindau’schen Krankheit (Angiomatosis des Zentral- nervensystems und der Retina) Schweiz. Arch. f. Neurol. 11. Psychiat. 36: 257-270, 1933. This is a lengthy report of a patient with angiomatosis of the retina and a cyst of the cerebellum. In the wall of the cyst was a small angioblastoma that was removed by operation. The case is reported as one of Lindau’s disease. There are no photomicrographs but there is a photograph of the retina. The author has reviewed the literature and includes a long bibliography. CHARLESA. WALTMAN

Exophthalmos from Orbital Tumor, J. L. DEHOGUES. Exophtalmie par tumeur orbitaire, Ann. d’ocul. 172: 907-912, 1935. 1 he tumor in the case here reported was an oligodendrocytoma of the optic nerve, causing unilateral exophthalmos. Eight photomicrographs and a few references to the literature are included. CHARLESA. WALTMAN

Glioma of the Optic Nerve, Report of a Case, C. WESKAMP. Arch. Ophth. 13: 630-633, 1935. Gliomas of the optic nerve or blastomas originating in the glial or neuroglial tissue of the optic nerve have no relation to the so-called gliomas of the retina; the latter are clinically and pathologically malignant neoplasms which develop during the first years of life. The author reports the case of a nineteen-year-old girl in whom a marked exophthal- inos of the left eye was caused by a cyst involving the entire optic nerve. This cyst was removed surgically with the portion of the optic nerve between the globe and the optic foramen. Eighteen months after operation the patient’s eye was in excellent condition in spite of the divisions of the central vessels and the ciliary nerves. A photograph of the patient before and after operation and a photograph of the fundus illustrate the article. BENJAMINR. SHORE THE BREAST 597

THE EAR

Congenital Cholesteatoma, G. DE MARO. Le cholesteatome I‘ congenital ” du temporal, A propos d’un fait clinique, Acta oto-laryng. 22: 163-179, 1935. A cholesteatoma was removed from the ear of a patient with chronic otitis media. No microscopic sections were made but it was considered of congenital origin because of evidence of arrested development of the tympanic membrane. Much of the paper is taken up with a review of the literature and a discussion as to whether these tumors are true neoplasms or results of inflammatory processes. There are no photomicrographs. Bibliographic references are included. CHARLESA. WALTMAN

THE BREAST

Histopathology of Breast Tumors, H. LIMBURG. Beitrag zur pathologischen Histo- logie von Mammatumoren, Ztschr. f. Geburtsh. u. Gynak. 111: 353-371, 1935. In a series of 18 cases in which the gross or histologic structure of a breast tumor suggested but was not typical of carcinoma, radical amputation with dissection of the axilla was done in 3 cases and local excision of the growth in 15 cases. Further study of the specimens showed adenofibrosis with epithelial overgrowth in 6 cases, adenofibrosis with papillomas in 6 cases, adenofibrosis with epithelial overgrowth and papillomas in 2 cases, adenofibrosis with proliferation of glandular epithelium in 1 case, a discrete adenofibroma with a papilloma in 1 case, and a discrete adenofibroma with glandular proliferation in 2 cases. These patients have been observed from one to six years and in none has a recurrence been noted. From the study of this group it is believed that epithelial proliferation and overgrowth do not carry such an unfavorable prognosis as is often ascribed to them. The article is well illustrated with photomicrographs. BENJAMINR. SHORE

Pathologic Anatomy of Cancer of the Breast, J, L. NICOD. Considerations sur l’ana- tomie pathologique du cancer du sein, Bull. Ligue nat. suisse contre le cancer, No. 1, 1935. This is a plea for more detailed histological study of mammary cancer. WM. H. WOGLOM

Tumors of the Mammary Gland, T. J. SNODGRASS.Wisconsin M. J. 34: 624-627, 1935. An abstract of a Mayo clinic report and text-book material. The author recommends the excision of all adenomata of the breast in women from twenty to thirty. CHARLESA. WALTMAN

Cancer of the Breast, A. W. ERSKINE. Wisconsin M. J. 34: 623-624, 1935. The author, who is a radiologist, makes the sound statement that x-ray treatment is not a substitute for operation in carcinoma of the breast as a curative procedure. Treatment by radiation alone “ should only be advised for hopeless cases, for the aged, and possibly for carcinoma en cuirasse.” Whenever a permanent cure seems at all possible, treatment by radiation should be considered as an adjunct to surgery. Erskine accepts the figures of the German clinics showing that five-year cures are increased about 10 per cent when thorough postoperative radiation is given. He regards delay as the principal reason for the present “ disgraceful mortality rate ” in cancer of the breast and, as the technical details of surgery and radiation therapy are fairly well codified, it is upon this delay factor that the profession should concentrate. Three suggestions are made for amelioration of the situation. One is that in early cancer of the breast a simple amputation be recommended, as many women would consent to this who object to a radical operation because of mutilation, impairment of function of the arm, and the belief that the disease is spread by extensive operation. The author argues that among 100 early cases of cancer without palpable nodes, only about 15 per cent will be found to have microscopic node metastases, and of the latter group only three or four will be saved by a radical procedure. Hence these patients may 598 ABSTRACTS

better be sacrificed if the remainder can be induced to have an earlier operation. In other words, ‘I more lives will be saved by doing a simple amputation on 100 patients than by performing radical operations on the 90 who consent.” [The difficulty with this proposal from a practical point of view is that statistics show that we see but very little early cancer of the breast, for nearly 70 per cent of patients have axillary node invasion when they consult a physician, but of those reaching the surgeon with axillary nodes involved from 15 to 25 per cent obtain a five-year cure by radical surgery. See, for example, Mathews, F. S.: Ann. Surg. 96: 871, 1932 and 98: 635, 1933; Harrington: Surg., Gynec. & Obst. 56: 438, 1933; Harrington and Judd: Surg., Gynec. & Obst. 58: 440, 1934. For abstracts of these papers, see Am. J. Cancer 19:454, 1933; 22: 162, 1934; 20: 470, 1934; 23: 470, 1935.1 Secondly, Erskine makes the point that the profession should adopt a less optimistic attitude with the families of those patients who come with obvious metastases. He is convinced that the aggregate number of years of comfortable life for these advanced patients would be greater if they were accepted as hopeless, a simple amputation performed, and x-ray treatment used in an effort to retard the axillary, supraclavicular, and mediastinal extensions. [The abstractor does not believe that this will help the situation much from the social side. The patient’s family will regret the fact that the patient is hopeless but they are unlikely to enter upon an educational campaign to help others. byhen the diagnosis is made by the layman the patient is usually already beyond help. On the other hand, it is true that over-optimistic claims on the part of the surgeon have done much in the past to discredit surgery of the breast.] The third suggestion is the abandonment of the attempt to make a differential diagnosis between early cancer and benign tumor of the breast and hence to regard “ a lump in the breast as a positive indication for immediate operation.” [Erskine presumably means a mastectomy, and the application of this principle has been made by a considerable number of prominent surgeons, with the result, according to the abstractor’s experience, that out of 100 patients about three will have an early operation for cancer and ninety-seven will have their breasts unnecessarily removed. It is doubtful whether the average young woman should have a mastectomy for a neoplasm simply because an absolute diagnosis is not possible. With modern methods of suture of the skin, an exploratory. operation can be done in the breast, the tumor removed, a frozen section made, the diagnosis determined, and the skin sewed up so that no scar or mutilation results. The wide application of this technic is not objectionable provided surgeons will learn that neither mastectomy nor huge scars are a necessary consequence of the removal of a small breast tumor in a woman under fifty. The paper which follows Erskine’s is by a surgeon (Snodgrass), who recommends that all adenomata in those from twenty to thirty years of age should be excised (see preceding abstract).]

Simple Mastectomy with X-ray in Treatment of Cancer of the Breast, E. J. GRACEAND W. J. MOITRIER. New York State J. Med. 36: 701-704, 1936. The writers, on the basis of 40 patients, recommend simple mastectomy in carcinoma of the breast to be followed by x-ray therapy, and state that they obtained 44 per cent of five-year cures by this technic. [Though these figures be accepted at their face value, there is one phase of the matter which the authors seem to forget, and that is that x-ray will not control indefinitely the nodes in the axilla; if, furthermore, heavy radiation is employed in these circumstances, the connective-tissue scarring which results may cause most distressing edema of the arm. It has long been noted that after a proper excision of the axillary nodes, with the correct type of skin incision so that there is no scar in the axilla, recurrence in the axilla itself takes place in only an extremely small percentage of patients with advanced carcinoma of the breast. The suffering which is endured by patients with such recurrences, especially when the final nerve involvement occurs, is extreme, and even though the complete operation may not add more than 15 or 25 per cent to the five-year and ten-year survivals, the way in which the patient dies should have some weight. Those who die with bone metastases or lung involvement without edema of the arm and nerve invasion usually suffer relatively little: the others endure miserable deaths.] THE BREAST 599

Comparison of the Results in a Series of Cases of Carcinoma of the Breast Treated by Postoperative Roentgen Therapy for Prophylaxis with a Similar Series in Which Operation Was the Only Treatment, U. V. PORTMANN.Am. J. Cancer27: 1-25,1936. Portmann reports the results in two series of cases of breast carcinoma, one in which the only treatment was operative and one in which surgery was supplemented by roentgen therapy postoperatively. All cases in both series were operated on by the same surgeon and the roentgen therapy was administered by a single radiologist employing one technic. The final conclusions are based on 85 cases treated by surgery only and 99 receiving irradiation as well. Patients in Group I, those having localized growths with no clinical or microscopic evidence of axillary metastases, were cured by operation alone. In Group I1 cases, with moderate axillary involvement, but otherwise not extensive carcinoma, postoperative prophylactic irradiation prolonged life by one year. In Group 111, comprising the advanced cases, postoperative prophylactic irradiation also prolonged life for about one year. The author believes that in cases presenting clinical evidence of incurability operation is not only of no benefit but may actually be harmful. Such patients will live as long or possibly longer with irradiation alone. The author adds a note on the technic used in these cases which called for a maximum of 1600 to 2400 roentgens to each of three or four fields in a period of twelve to eighteen months, a very modest dosage compared with the newer technic of protracted therapy. Numerous tables show the results. A brief bibliography is appended.

Case of Cancer and Tuberculosis of the Breast, A. GRASSI. Di un caso di cancro e tubercolosi della mammella, Pathologica 27: 348-354, 1935. The coexistence of cancer and tuberculosis in the same area of the female breast in a patient in good general health with no signs of tuberculosis elsewhere in the body is reported. Fairly typical tubercles were found with giant and epithelioid cells and central necrotic areas. There was no calcification. No bacilli were demonstrated. In some sections the neoplastic cells appeared to be in a process of fusing to form giant cells. The author believes that the tuberculous process was superimposed on the neoplastic, probably by the blood stream route, the bacilli being dislodged from some inactive focus elsewhere in the body following on the disturbance caused by the growth of the cancer, and that the organisms became implanted in the breast following the circulatory changes there due to the cancer. He believes that the histologic picture suggest3 the possibility that in this case the epithelioid and giant cells of the tubercles arose from the cancer elements. Photomicrographs illustrate the findings. JEANNETTE MUNRO

Small Disseminated Neoplastic Nodules on the Trunk of a Woman with a Cancer of the Breast, Fr. WORINGER,AND G. MAYER. Petits nodules nkoplasiques dissbminks sur tout le tronc chez une femme atteinte d’un cancer du sein, Bull. SOC.frang. dermat. et syph. 42: 862-865, 1935. This is the report of a woman with an extremely malignant carcinoma of the right breast with metastases principally in the form of cutaneous nodules. There was extensive lymph node involvement and marked ascites apparently from peritoneal masses, but no bone lesions were demonstrated. The liver and spleen were not palpable. There are no illustrations and no references. THEODOREP. EBERHARD

Double Cancer of the Breasts in a Smhilitic. A. TOURAINEAND DUPERRAT. Cancer dquble des seins chez une syphilitiiu-e, Bull: SOC.frang. dermat. et syph. 42: 727-730, 1935. Double primary cancer of the breast is relatively rare. Interest is added to the authors’ case by the differing nature of the two tumors and by the presence of a poorly treated syphilis of long standing. The patient presented herself five years after the tumor of the right breast had appeared and eight months after that of the left breast. The first tumor was a scirrhous, atrophic, ulcerated cancer-en-cuirasse which microscopically showed tiny islands of 600 ABSTRACTS

malignant epithelial cells lying in an abundant, dense, fibrous stroma. The second tumor caused a rather regular globular enlargement of the left breast; it was hard, not ulcerated, but adherent to both skin and deep fascia. Removal of this breast was done. Micro- scopic sections showed in the midst of the abundant, fibrous, almost acellular stroma occasional acini of epithelial cells. There were extensive metastases from the first tumor before the second appeared, involving the skin and the spine, but the authors feel sure that the tumor in the left breast was not a metastasis. The blood Kahn and Hecht tests were negative, but the patient gave a history of syphilis at the age of twenty with sporadic iodide treatment for one year afterwards. The histological descriptions are brief and there are neither illustrations nor references to the literature. THEODOREP. FlBERHAKD

Mastoma, H. DUBOUCHEII,J. MONTPELLIER,AND LAPFARCUE. La mastome, Gaz. hebd. d. sc. mitd. de Bordeaux 56: 325-330, 1935. A woman thirty-six years old had had a tumor in one breast for several years. During pregnancy and lactation it became greatly enlarged. It was attached to the breast by a large pedicle. In addition, the patient possessed two accessory breasts without nipples. After removal the pedunculated tumor weighed 450 gm. and measured 12 x 5 cm. Histologically, it had the appearance of a lactating breast with scattered cystic and atrophic areas. To this glandular type of tumor the term ‘I mastoma ” is applied according to the observations of Prym (Beitr. z. path. Anat. u. z. allg. Path. 81 : 1, 221, 1928-29). There are two photographs showing the gross appearance of the tumor and one photomicrograph, and a short bibliography is included. CHARLESA. WALTMAN

THE ORAL CAVITY AND UPPER RESPIRATORY TRACT

The Reaction and Necrotic Changes Following Radium Therapy in Cancer of the Mouth, N. A. AMODEO. Reazioni ed alterazioni necrotiche nella curie-terapia del cancro della bocca, Arch. chir. oris 3: 1-46, 1935. This is a very able description of the early and late radiation reactions following the use of radium in cancer of the mouth. The author has drawn his experience from the treatment of 450 cases of cancer of the mouth since 1928 at the Cancer Institute of the University of Milan. Most of the cases were treated with interstitial radium in needles. Amodeo first describes, and illustrates with several photographs, the early stomatitis following the use of radium. He includes suggestions as to the use of various types of irrigations to keep the mouth clean and the patient comfortable. He then describes in detail 23 cases in which late radium necrosis occurred. In 10 of these patients the necrosis involved soft parts only, while in the other 13 there was late osteonecrosis. The discussion of this complication is among the most well considered that this abstractor has read. Amodeo traces the stages in the development of osteonecrosis as follows: the stonlatitis following radium results in retraction of the gums, partially exposing the roots of the teeth. Chronic inflammation of the dental pulp follows and often eventuates in gangrene of the dental pulp. Teeth in this condition serve as a focus for bacteria which set up inflammation and necrosis in the bone surrounding them, the nutrition of which has been damaged by the previous radiation. Such teeth must be extracted. If this is done promptly, sequestration of the necrotic bone and eventual healing usually occur. Most of the author’s cases with late radionecrosis not only survived this complication but were cured of cancer. Amodeo believes that the extraction, before radiation treatment is begun, of teeth that show decay, retraction of the gums, apical abscesses, and those with a dead pulp, will prevent the development of late osteonecrosis. Such extractions need not delay the institution of radiotherapy longer than forty-eight hours. Nineteen good photographs and an extensive bibliography are included. C. D. HAACENSEN THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 60 1

Changes in the Bacterial Flora of the Oral Cavity in Ulcerated Neoplasms Treated with Radium, N. A. AMODEO. Sulle variazioni della flora microbica della cavitd orale in forme neoplastiche ulcerate sottoposte a Curie-terapia, Boll. d. 1st. sieroterap. milanese 14: 478-488, 1935. In a series of eight cases of cancer of the mouth treated by interstitial radium, the author studied the bacterial flora of the ulcerated tumor before treatment and for a considerable time afterwards. He reports a definite increase in the proportion of Gram- positive organisms after radiation. This increase is usually due to the appearance of hemolytic streptococci, less often to pseudo-diphtheritic bacilli, and in occasional cases to Staphylococcus aureus. Thus radiotherapy favors infection, which, in turn, sometimes retards the cure of the cancer. C. D. HAAGENSEN

Carcinoma of the Tongue in a Newborn Child: Report of a Case, L. ALLAC ACE FRANK, C. D. ENFIELD,AND A. J. MILLER. Am. J. Cancer 26: 775-777, 1936. The authors report a carcinoma of the tongue in a newborn child treated by excision and subsequent x-ray irradiation of the neck, the latter instituted eight days after operation and twenty-two days after birth. Two years later there was no evidence of recurrence. Two photomicrographs of the tumor are included.

Round Cell Sarcoma of the Tongue, Tonsil and Soft Palate, T. J. HOLTON. South. Med. & Surg. 97: 544-555, 1935. The author’s patient was a seventy-three-year-old man who had been subjected to a radical neck dissection and complete glossectomy in 1902 because of an ulcerating tumor involving the right side of the tongue, right tonsil, soft palate, and presumably the right cervical lymph nodes. Histologic study of a biopsy specimen led to the diagnosis of round-cell sarcoma, but there are no illustrations and no detailed description of the histology is given. It is now thirty-two years and ten months since this radical dissection of the neck and complete removal of the tongue. The patient chews his food, then closes his mouth before allowing the food to be released from the teeth, and, with a quick toss of his head, throws the masticated food into the gullet. Liquids are taken into the mouth and swallowed in the same manner. Speech is monotone in character. BENJAMINR. SHORE

Cysts of Roots of Healthy Teeth in Children, P. JACQUES. Kystes radiculaires sur dents saines chez les enfants, Ann. d’oto-laryng., pp. 949-952, September 1935. Two cases of dental cysts arising from roots of healthy teeth in children are reported. No malignant elements were present. There is no bibliography. CHARLESA. WALTMAN

Mixed Tumors of the Palate, A. B. ABSHIER. Arch. Dermat. & Syph. 32: 622-625, 1935. With the exception of the parotid and submaxillary glands, the palate is the most frequent site of mixed tumors. Even here, however, they are relatively rare. The author reports 6 cases, in only one of which is a follow-up given and that is of a recurrence seven years after operation. A photograph of a typical mixed tumor of the palate is included. A few references are appended. Eggers in a survey of the literature found 87 authentic cases of mixed tumors in this location (Arch. Path. 6: 378, 1928). His paper contains an extensive bibliography.

Contribution to the Radiological Study of Malignant Tumors of the Maxillary Sinus, A. RATTI. Contributo radiologico allo studio dei tumori maligni del sen0 mascellare, Radiol. med. 22: 1-25, 1935. This is a description of the roentgenographic signs of malignant tumors of the antrum, illustrated by a series of 25 reproductions of roentgenograms in health and disease. Soft part changes have little diagnostic significance, for they are produced by inflammatory as well as neoplastic lesions, but erosion of the bony walls of the antrum is 602 ABSTRACTS

of great importance. These bony changes are difficult to show at times and their demonstration requires a special technic, for which the original paper should be consulted. C. D. HAAGENSEN

Osteoma of the Frontal Sinus, MOULONGUETAND DEMALDENT.Un cas d’ostCome frontal, Ann. d’oto-laryng., pp. 1107-1 109, October 1935. A patient with frontal headaches was found to have an osteoma of the left frontal sinus. The tumor was removed. It was not malignant. CHARLESA. WALTMAN

Mixed Tumor of the Nasal Fossa, GRIVOTAND LALLEMAND.Tumeur mixte de la fosse nasale, Ann. d’oto-laryng., pp. 1106-1 107, October 1935. Besides nasal polyps the patient had a mixed tumor of the nasal fossa, which is described briefly. CHARLESA. WALTMAN

Histopathology of Nasal Polyps, M. RATENBERG.Sur l’histologie pathologique des polypes de la ’muqueuse nasale, Ann. d’oto-laryng., pp. 1071-1086, October 1935. A discussion of the histology of nasal polyps with six photomicrographs. No cancer is reported. A bibliography is added. CHARLESA. \VALTIMAN

Combined Distance Radiation of Hypopharyngeal Cancer, STANFORDCADE AND F. M. ALLCHIN. Lancet 2: 652-656, 1935. The author’s method of treating extrinsic laryngeal cancer, including hypopharyngeal lesions, combines roentgen and radium irradiation as follows : (1) preliminary roentgen irradiation for five days; (2) simultaneous roentgen and gamma irradiation ; (3) gamma irradiation with a 2 gm. radium unit. By such a combination it is believed that a larger dose can be given with safety, that because of the variation of wavelength the degree of radiosensitivity is increased [not true]; that the local tolerance of the skin and mucous membranes is increased; that the limit of general tolerance of the patient is never reached before the limit of the local tolerance of the skin or mucous membrane, so that treatment need not be interrupted before an adequate dose is delivered. Details of technic and dosage are given, and the results in a series of 52 cases are summarized. Seventeen patients were without evidence of disease at the time of the report but in no instance did the period of observation exceed three and a half years.

Cancer of the Hypopharynx Treated with Radium, LALLEMAND.A propos de la radiumpnncture en laryngoscopie en suspension des cancers de I’hypo-pharynx, Ann. d.’ota-laryng., pp. 1111-11 13, October 1935. The author has treated 16 cases of cancer of the hypopharynx by the application of radium needles with the aid of a suspended laryngoscope, which leaves both hands free. Two patients have been free of disease for two years; in fourteen there has been a recurrence. There are no photographs. CHARLESA. WALTMAN

Fibroma of the Nasopharynx, WORMS. IJn cas de fibrome naso-pharyngien, Ann. d’oto-laryng., pp. 11 13-1 114, October 1935. This is a discussion of technic for removal of fibromas of the nasopharynx, especially when they involve the sphenoid region. An illustrative case is briefly reported. CHARLESA. WALTMAN

Lympho-epithelioma of the Tonsil, R. KIENBOCKAND A. SELKA. uber das Lympho- epitheliom der Rachnemandel (Schmincke-Tumor), Fortschr. a. d. Geb. d. Riintgen- strahlen 52: 227-233, 1935. A forty-year-old man had a malignant tumor originating in the right tonsil. His- tologic study of two biopsy specimens showed a squamous-cell epithelioma and lympho- rpithelioma. The primary lesion was treated by radium [amount not stated], with complete disappearance of the growth. Eighteen months after this, metastatic tumors THE THYROID GLAND 603

in the femurs, tibias, and the skull were demonstrated roentgenologically. These metastatic areas were treated by irradiation with some relief of pain but without influencing the course of the disease. Histologic study of the metastases was not done. The article is illustrated with roentgenograms. BENJAMINR. SHORE

Surgical Treatment of Cancer of the Larynx, G. PORTMANNAND J. DESPONS. A propos du traitement chirurgical du cancer du larynx et de ses rbsultats, Gaz. hebd. d. sc. mCd. Bordeaux 56: 413-414, 483-487, 1935. The authors report 46 cancers of the larynx, of which 36 were treated surgically. The other 10 were not treated or were given radiotherapy. Nine of 16 cases with total laryngectomy, 12 of 17 cases with partial laryngectomy, and 2 of 3 cases with cordectomy were followed for more than a year. Nineteen cases are described as definite cures, although the exact period of follow-up is not given. Complications of the operations are described. The authors favor partial laryngectomy. There are no pathological descriptions, and the paper is unillustrated. No bibliography is included. CHARLESA. WALTMAN

Epithelial Cyst of the Vocal Cord, E. KNAPP. Eine Epithelzyste des Stimmbandes, Monatschr. f. Ohrenh. 69:87-92, 1935. A small epithelial cyst of the vocal cord was excised under the diagnosis of polyp. Histologic study showed the lining of the cyst to be squamous epithelium probably of congenital or traumatic origin. The article is illustrated with photomicrographs. BENJAMINR. SHORE

Thyrohyoid Cyst, M. OMBR~DANNE.Curieuse histoire clinique d'un kyste thyro- hoidien, piece operatoire et resultat, Bull. SOC.de pbdiat. de Paris 33: 156-161, 1935. A nine-year-old boy had a thyroglossal cyst, the duct of which extended to the hyoid bone. The cyst was removed successfully. The report is without photographs or bibliography. CHARLESA. WALTMAN

SALIVARY GLANDS

Salivary Gland Tumour, D. C. L. FITZWILLIAMS.Lancet 2: 769, 1935. A woman of forty-four was operated on in 1930 for a mixed tumor of the submaxillary gland. Two recurrences were removed in 1932, and the following year a large, painful swelling in the same region was treated by interstitial radium irradiation, as the extent of the growth seemed to contraindicate further surgery. The pain was relieved and the tumor eventually disappeared locally, but fifteen months later respiratory symptoms developed. At autopsy a hard mass was found on the left side of the neck extending from just below the auricle to the midline and reaching the lateral wall of the pharynx. Neither the parotid nor submaxillary glands could be identified in this mass. The deep cervical nodes were involved, and the lungs and the pleural surface of the diaphragm contained numerous tumor nodules. These showed the structure of a very cellular salivary gland tumor. No photomicrographs are included.

THE THYROID GLAND

Carcinoma of the Thyroid in a Young Girl, F. KRIEGLSTEIN.Uber ein papillares Zystokarzinom der Schilddruse bei einer Jugendlichen, Med. Klin. 31: 1399-1401, 1935. An enlarged cervical lymph node removed from a fourteen-year-old girl contained metastatic carcinoma. No thyroid tumor was palpable, and rectal examination was negative. Exploration of the thyroid revealed a tumor of the right lobe. Histologi- cally, the tumor was papillary and cystic. Small lymph nodes attached to the capsule 604 ABSTRACTS contained metastases which produced colloid, but there was no invasion of blood vessels. No metastases to the lungs were seen. [It is regrettable that no follow-up of this case has been recorded, for the sections which are reproduced do not look like carcinoma, and aberrant nodules of abnormal thyroid tissue in the neck have frequently been mistaken for metastases. If the patient had had a carcinoma she would probably have shown extensions elsewhere in a few months.] A short bibliography is appended. CHARLESA. WALTMAN

Thyroxin Production in Metastases from Carcinoma of the Thyroid, ROLF BULL ENGELSTAD.Am. J. Cancer 26: 738-742, 1936. Engelstad reports two cases in which it was possible by biological examination to demonstrate the production of thyroxin by tumors metastatic from the thyroid, thus confirming the diagnosis. The method, which he describes in detail, is based on the observation that thyroxin increases the resistance of white mice to acetonitril (Hunt: Am. J. Physiol. 63:257,1923). Photomicrographs of the metastatic tumors are included.

I NTRATH 0 RACI C TUM ORS Intrathoracic Neoplasms, II. P. NELSON. Post.-Grad. M. J. 11: 25-33, 1935. Pulmonary neoplasms may be roughly divided as follows: (1) tumors arising in a primary or secondary bronchus causing obstruction, collapse of the lung distal to it, and infection; (2) tumors arising in a large bronchus and extending to the mediastinuni; (3)tumors arising in a tertiary bronchus and spreading outward; (4) rounded tumors in the lung substance; (5) localized tumors in a bronchus without lung or mediastinal invasion. Nelson illustrates the radiographic appearance of these various types with clear diagrams and several roentgenograms. He discusses the signs and symptoms and methods of diagnosis and treatment. Only in the three rarer types, localized intra- bronchial, parenchymal and peripheral tumors, is an attempt at curative treatment by radical surgical removal justified. Localized bronchial tumors may be reduced in size by seeding with radon before removal through the bronchoscope. Canalization of a bronchus obstructed or about to be obstructed by tumor with a radon tube is recommended, as is the seeding of inoperable tumors with radon when they have been exposed by exploratory thoracotomy. Mediastinal tumors may be divided into: (1) those arising in lymphatic tissues; (2) intrathoracic goiters; (3) fibromas and fibroneuromas; (4) dermoids. The response of the first variety to radiation is striking. The last three types are surgical problems. Pleural neoplasms include localized tumors, the so-called “ giant sarcomas,” and diffuse tumors called usually endotheliomas or mesotheliomas. Tumors of the last group occur with four times the frequency of the first. GRAYH. TWOMBLY

Cancer of the Lung, H. E. BOCK. Zur Klinik des Lungenkrebses, Munchen. med. Wchnschr. 82: 2063-2067, 1935. From 1926 to 1934, 45 cases of primary carcinoma of the lung were seen in the University Medical Clinic in Frankfurt a. M. There were 39 men and 6 women. The right lung was affected 26 and the left 19 times. Characteristic symptoms such as a cough, sputum, and bronchial or intercostal pain were present in 28 cases, while symptoms referable to the stomach were present in 7 cases, to the heart or mediastinum in 4 cases, to the brain in 2 cases, to the bones and liver in 1 case each, and in 2 instances the symptoms could not be localized. To be differentiated from primary carcinoma of the lung are tuberculosis, lung abscess, and bronchiectasis. Treatment is not discussed. There are no illustrations. BENJAMIN R. SHORE

Primary Cancer of the Lung, T. T. GLOUHENKY.Cas de cancer priniaire des poumons, NCoplasmes 14: 164-170, 1935. On the basis of 25 examples of pulmonary carcinoma the author questions the etiological importance of influenza1 infection, traumatism, or exposure to dust or to exhaust gases from automobiles. WM. H. WOGLOM INTRATHORACIC‘ TUMORS 60 5

Etiology of Bronchial Carcinoma, F. THYS. Note sur I’Ctiologie du carcinome bronchi- que, Rev. belge d. sc. mCd. 7: 640-644, 1935. In the past two years 2.5 per cent of the cancers seen by the author were primary in the lungs. In the preceding ten years this diagnosis had not been mentioned. Since all cases are autopsied, the increase is probably not due to better diagnostic methods. The author attributes it to the inhalation of tobacco smoke. No experimental work was done to verify this opinion. One reference to the literature is included. CHARLESA. WALTMAN

Carcinoma of the Lung in Joachimsthal Miners, R. ZIEL. Zur Frage des Lungen- krebses bei den Bergleuten Joachimsthals, Med. Klin. 31 : 1535-1536, 1935. Routine post-mortem studies on workers in the Joachimsthal area showed carcinoma of the lung in 9, or 45 per cent of 20 bodies examined in 1929-30, and in 4, or 30 per cent of 15 bodies examined in 1933-34. These tumors occurred in persons who had worked for long periods of time in the more dust-laden atmospheres. The results obtained by better ventilation and control of dust are as yet undetermined. [For an excellent accouct of cancer of the lung in the Joachimsthal miners, see the paper by Pirchan and Sikl in Am. J. Cancer 16: 681, 1932.1

Pneumonectomy for Malignant and Suppurative Disease of the Lung, with a Report of Eight Cases, R. H. OVERHOLT. J. Thoracic Surg. 5: 54-75, 1935. Within the past eighteen months, 13 patients with carcinoma of the lung have been operated on at the Lahey Clinic; pneumonectomy was performed in 6 patients; in the remaining 7 this could not be accomplished because of mediastinal involvement. It has been the author’s policy: (1) to explore all cases of proved carcinoma of the lung if an extension beyond the lung could not be demonstrated by roentgenograms; (2) to explore in the face of a negative bronchoscopic report if the history and roentgenograms suggest a peripheral neoplasm. In a series of 23 primary carcinomas of the lung studied within the past three years, 18 were main bronchus tumors. Biopsies for histologic study were taken through a bronchoscope in 15 cases and a positive diagnosis of carcinoma was possible in 14 cases. This suggests that the diagnosis of bronchial carcinoma can be definitely established by bronchoscopy in the majority of cases. The anterior surgical approach is favored for operation on either lung for the following reasons: (1) it allows a more thorough inspection and palpation of the mediastinum; (2) it provides a more accessible approach to the hilum; (3) it makes separate ligation of the vessels and bronchus possible; (4) it permits a dorsal position of the patient on the table; (5) the convalescent period is far more comfortable because the posterior thoracic cage is intact. There are, however, two definite indications for using the postero- lateral approach. In cases of peripheral tumors in which infiltration of the lateral chest wall is indicated in roentgenograms, it is well to place the incision so that the involved portion of the chest wall can be removed with the lung should exploration show the mediastinum to be free of metastases. A postero-lateral incision should also be considered in the potentially infected case where a short operation is desired and where a separate ligation of the pulmonary vessels with a division of the bronchus near the carina is not required. Histories of eight cases are included, with roentgenograms, drawings, and photographs. BENJAMINR. SHORE

Superior Pulmonary Sulcus Tumour, A. E. CONNOLLY.Brit. J. Radiol. 8: 781-786, 1935. A further case of superior pulmonary sulcus tumor is reported. The patient was a man aged fifty-five years, who was admitted to the hospital with pain in the right shoulder of five weeks’ duration, numbness of the forearm with a tingling sensation to the fingers, and a patch of anesthesia on the inner aspect of the forearm. Horner’s syndrome was present on the affected side. Radiological examination revealed an apical shadow. At a later stage there was extension of the opacity to the soft parts of the neck and local bone destruction was evident. Examination of necropsy material 606 ABSTRACTS

revealed an epithelial growth, which apparently originated in the bronchioles at the apex of the lung. Two roentgenograms illustrate the report. [For other reports of superior pulmonary sulcus tumors and opinions as to the origin of these growths see Absts. in Am. J. Cancer 19: 168, 1933; 23: 648, 1935; 25: 869, 1935; also original articles by Steiner and Francis: Ibid. 22: 776, 1934; Browder and De Veer: 24: 507, 1935; Frost and Wolpaw: 26: 483, 1936.1

Metastatic Involvement of the Pericardium with Compression of the Inferior Vena Cava, R. DUPBRIB,GRB, DERVILLBEAND DUTRBNIT. Symphyse nkoplasique du pkricarde, avec syndrome de compression de la veine cave infkrieure, Gaz. hebd. d. sc. m6d. de Bordeaux 56: 599-602, 1935. A patient with severe dyspnea had edema of the lower extremities, abdominal wall, lumbar region and lower thorax, but no ascites. At autopsy a primary carcinoma of the lung was found. This had invaded the pericardium but not the heart muscle. The entire cardio-pericardial mass weighed 1440 grams. Involvement of retro-cardiac nodes obstructed the inferior vena cava. A diagram shows the thickness of the pericardium and heart muscle. A brief discussion of the literature concludes the article. CHARLESA. WALTMAN

Roentgen Diagnosis of Mediastinal Neuromas, W. N. BOBRETZKAJAAND J. I. HEINIS- MANN. Beitrage zur Rontgendiagnostik der mediastinalen Neurinome, Fortschr. a. d. Geb. d. Rontgenstrahlen 52: 191-199, 1935. The symptoms produced by mediastinal neuromas are dependent upon the size and 'position of the tumor. Pressure symptoms are common and a Horner's syndrome and thenar atrophy are seen when the tumor involves the cervical sympathetic trunk. Roentgenologically the tumors are characterized by being unilateral, homogeneous, sharply defined, and with a long axis corresponding with the long axis of the individual. Destruction of neighboring bone is usually dependent upon malignant degeneration of the growth. Six illustrative cases with roentgenograms are included. BENJAMINR. SHORE

Reticulum-cell Sarcoma of the Mediastinum, P. VERRYKEN. Rkticulosarcome du mediastin, Rev. belge sc. m6d. 7: 234-239, 1935. The patient presented the clinical syndrome of a mediastinal tumor. At autopsy the tumor was found to occupy the anterior superior part of the mediastinum, surrounding the great vessels of the heart and the main bronchi. Histologically, it was composed of reticulum cells. There were no epithelial cells and the lymphoid tissue had disappeared. A photograph and photomicrograph of the tumor are included. CHARLESA. WALTMAN An Intrathoracic Entoderm Cyst of the Posterior Mediastinum in a New-born Child, K. H. STOECKEL.Uber einen Fall von intrathorakaler Entodermcyste im Mediasthum posterius bei einem Neugeborenen, Zentralbl. f. Gynak. 59: 2178-2183, 1935. An intrathoracic cyst was found in the posterior mediastinum of a full-term infant who died twenty minutes after delivery. The cyst was about 5 cm. in diameter and contained a clear, light-yellow fluid. The wall was about 5 mni. thick. Histologic study showed the lining of the cyst to be composed of a single layer of cylindrical epithelium. Lymphoid tissue and cartilage were lacking. A photograph and two photomicrographs illustrate the article. BENJAMINR. SHORE

THE DIGESTIVE TRACT

Treatment of Carcinoma of the Lower End of the Oesophagus, R. MAILER. Lancet 2: 1052-1054, 1935. Mailer discusses the difficulties in the treatment of lower esophageal cancer and describes a method of radium therapy which he has used in 11 cases. Fluoroscopy is THE DIGESTIVE TRACT 607 done to determine the extent of the growth, and the diagnosis is verified by esophagos- copy, at which time a portion of tissue is removed for microscopic study, to make sure that the growth is a squamous epithelioma and not the slower growing adenocarcinoma or a syphilitic lesion. A gastrostomy is performed and after about a week the patient swallows a silk thread. At the end of forty-eight or seventy-two hours the gastrostomy tube is removed and with a small hook the thread is pulled to the surface. Very gradual dilatation of the stricture is then carried out by attaching rubber catheters to the silk and pulling them up through the stricture towards the mouth. A larger caliber catheter is used each day until a size 14 to 16 English passes easily. For the radium treatment either a catheter of this caliber is used to begin with, or a special thick-walled rubber tube with a small metal olivary tip which is perforated to allow the passage of the thread. Thirty mg. of radium are used, in the form of 5 mg. needles arranged in tandem, the active length being 4 inches. This allows the radium to project 1 inch above and below the apparent limits of the growth in an average case. The position of the tube is checked by radiography, and daily treatments of four to six hours are given. The total treatment extends over 100 to 130 hours, depending upon distance. When the radium is not in position the patient is fed by catheter through the gastrostomy opening, and is also allowed fluids by mouth. When the treatment is over, the gastrostomy wound is allowed to close. If necessary, further dilatation is carried out with metal-tipped bougies and in some instances a second radium treatment is given. Among the author’s 11 cases there were no deaths during treatment; the longest survival was three years and a half; 4 other patients lived more than a year. In spite of the poor prognosis the treatment is considered well worth while for its palliative effect.

Report of a ‘‘ Proved Cured Case ” of Squamous Cell Epithelioma of the Esophagus Treated by Intraesophageal and External Irradiation, A. CRUMPAND H. KASABACH. J. Thoracic Surg. 5: 157-164, 1935. The authors report the case of a sixty-three-year-old man with an esophageal carcinoma proved by histologic study of a biopsy specimen. The growth extended from the level of the 6th cervical to the 3rd dorsal vertebra. Four 10 mg. radium tubes were inserted through a special esophageal applicator, which was so placed that the radium remained at the level of the neoplasm. The position of the radium was checked by fluoroscopy and roentgenographically. The total length of the radiation surface was 10 cm. The distance from the center of the applicator to the esophageal mucosa was 3 mm.; the filtration was 1 mm. of platinum plus the applicator metal, the latter being equivalent to 0.25 mm. of platinum. The total linear dose was 800 mg. hours given in twenty hours. About ten days after this treatment the patient complained of increased difficulty in swallowing, and four months later a gastrostomy was performed because of progressive loss of weight. A second course of radium irradiation similar to the first was given three weeks after the gastrostomy. This was soon followed by a long series of deep roentgen therapy in fractional doses of 150 to 300 roentgens daily. A total of 1800 r were given through each of the anterior and posterior fields and 2400 r through each of the lateral fields. About a month afterward the patient began to swallow liquids with little difficulty. Esophageal examination nine months after the first radium treatment showed a persistent stricture but no neoplastic tissue. Despite this observation, the radium applicator was applied in the esophageal lumen for the third time under avertin anesthesia. This treatment, however, was not completed because the patient began to cough and was cyanotic. He died shortly afterward, probably as a result of the anesthesia. Autopsy showed a constriction in the esophagus at the level of the cricoid cartilage. The mucosa in this area was smooth and congested, but there was no ulceration or evidence of tumor. Histologic study of various areas failed to show residual neoplasm. The article is illustrated with roentgenograms, a photomicrograph, photograph, and drawings. BENJAMINR. SHORE Report of a Case of Esophagogastrostomy for Carcinoma of the Esophagus, H. R. DECKER.J. Thoracic Surg. 5: 143-156, 1935. The author reports the case of a forty-eight-year-old man with an esophageal carcinoma 6 cm. long, situated 10 cm. above the diaphragm. This tumor was removed 608 ABSTRACTS transthoracically. 'The proximal end of the esophagus was sutured to the fundus of the stomach, which was pulled upward through a hiatus in the diaphragm. The patient died of circulatory failure twenty-eight hours after operation. The article is illustrated with several drawings. Icggers in discussing this case reported on a fifty-year-old patient of his own who had been operated upon for esophageal carcinoma in a similar manner. This patient died of mediastinitis eleven days after operation. In spite of this failure, Eggers believes that success may be attained in some future case. BENJAMINR. SHORE

Cancer of the Esophagus with Respiratory Symptoms, JOUSSEAUME. Les fornies respiratores du cancer de l'oesophage, Ann. d'oto-laryng., pp. 1053-1061, October 193.5. The author has reviewed the literature of reports of cases of carcinoma of the esophagus in which the first symptoms were referable to the respiratory tract. A bibliography is given. CHARLESA. WALTMAN Differentiation between Benign and Malignant Hemorrhage in the Gastro-intestinal Tract, I. BOAS. Uber die Unterscheidung benigner von malignen Rlutungen des Magendarmkanals, Ileutsche med. Wchnschr. 61 : 2003-2006, 1935. Benign hemorrhages of the gastro-intestinal tract, including the esophagus, are such :is are caused by ulcers or benign tumors, whereas malignant hemorrhage is associated with malignant growths. Differentiation between the two is based upon exact analysis of the feces. IJntil very recently examinations for blood pigment were confined to a search for hemin by methods which have become outmoded. It is now necessary to examine the stools repeatedly for occult hemoglobin or its derivatives. One single test, obviously, is useless for the purpose of differential diagnosis, as only repeated determinations ran show the gradual disappearance of hemoglobin (benign hemorrhage) or its persistent presence (malignant hemorrhage). Still more important is the behavior of the stercoporphyrin. In benign hemorrhages the porphyrin content of the feces is low, especially that of deuteroporphyrin and protoporphyrin; in nialignant hemorrhages it is independent of the hemin value, but considerably elevated as a rule. R simple and practical method of determining the porphyrin content of the feces is described. WM. H. WoC;Lohi Development of Achlorhydria and Pyloric Stenosis in Cases of Carcinoma of the Stomach, J. DOUGLASROBERTSON. Lancet 1: 149.5-1497, 1935. Two conflicting views exist as to the occurrence of achlorhydria in the presence of gastric cancer. According to one there is no fall in the secretion of free hydrochloric acid as the disease advances. According to the other, not only does such a fall occur but it is an early event and of diagnostic value. Two cases are reported in which repeated test meals revealed a gradual disappearance of free hydrochloric acid. At the same time definite alterations in the motility of the stomach occurred and pyloric stenosis developed. The author attributes the diminution of hydrochloric acid in these cases to the intractable gastritis secondary to the development of pyloric stenosis. From the point of view of early diagnosis, however, the achlorhydria was of no significance, as the carcinoma was well advanced in both cases when the first test meal was given. A short bibliography is appended. In a letter commenting on this communication (Lancet 2: 46, 1935) J. A. Ryle calls attention to the demonstration many years ago of a gradually developing achlorhydria in obstructive pyloric carcinoma, by Colding Bird (London M. Gaz. 1841-42, pp. 391 and 426).

Ulceration as a Symptom of Gastric Cancer, A. KAHLSTORF. Die Nische als Symptom des Magenkrebses, Deutsche med. Wchnschr. 61 : 1839-1842, 1935. There are two forms of ulceration due to malignant gastric tumors which can be delineated in roentgenograms. The first is a wide plateau-forming type, which is al- THE DIGESTIVE TRACT 609 ways carcinomatous. The second is a smaller, deeper defect which resembles an ordinary benign ulceration, but in which the duration of previous symptoms is apt to be shorter and there is no response to the ordinary medical treatment for ulcer. Several roentgenograms illustrate the article. BENJAMINR. SHORE Carcinoma of the Stomach. Problems in Differential Diagnosis, M. DAVIDSON. Post-Grad. M. J. 11: 221-225, 1935. A man of forty-three had a sore throat and pains in the neck and back for ten days, followed by a severe hematemesis. On admission he was semi-delirious, with marked pallor and cold extremities. Abdominal examination revealed only slight distention. The blood count showed red cells 2,000,000; white cells 21,000; platelets 30,400. The bleeding time was nine minutes. A diagnosis of thrombocytopenic purpura hemor- rhagica was made, though no petechiae were present. Ten days after admission a severe rectal hemorrhage took place and operation was advised in an attempt to locate and possibly ligate the bleeding vessel. A large, inoperable carclnoma was found on the posterior wall of the stomach, and the patient died five days later. A man of twenty-four complained of upper abdominal pain and vomiting. X-rays of the stomach showed what was thought to be an ulcer on the greater curvature. An ulcer diet was instituted and the symptoms disappeared. A month later pain returned. Two months after treatment the patient was seized with severe abdominal pain thought to be due to perforation of the ulcer. Exploration eighteen days after the onset of the acute attack revealed a large inoperable carcinoma of the cardiac end of the stomach. Death occurred twelve days after operation. GRAYH. TWOMBLY Radiological Behavior of the Duodenum in Gastric Tumors, A. RATTI. Sul comportamento radiologico del duodeno in presenza di tumori gastrici, Radiol. med. 22: 805-829, 1935. In the presence of carcinoma of the lower half of the stomach, Ratti has often observed functional changes in the duodenum. These consist chiefly in atony of the duodenal bulb and stasis in the second and third portions of the duodenum. These changes appear not only when there is incompetence of the pylorus but also when there is delayed emptying of the stomach. Ratti believes that this delay in the emptying of the second and third portions of the duodenum is an indication of extension of the carcinoma to the paraduodenal tissues and is therefore a contraindication to operation. The paper is illustrated by reproductions of 18 series of roentgen films. A bibliography is included. C. D. HAACENSEN Gastric Carcinoma with Normal Erythrocyte Sedimentation Reaction, L. J. WITTS. Lancet 1: 1329, 1935. This is a brief clinical note concerning a gastric tumor in a man of thirty-two who showed no change in the erythrocyte sedimentation rate. The tumor was removed and proved to be a spheroidal-cell carcinoma with involvement of the regional lymph nodes. Carcinoma and Polyposis in the Same Stomach, C. RENNER. Zur Frage der Karzi- nomentwicklung auf dem Boden einer Polyposis des Magens, Centralbl. f. allg. Path. u. path. Anat. 64: 8-12, 1935. The author reports the case of a seventy-four-year-old woman in whom a typical benign polyp and an infiltrating carcinoma of the stomach were found at autopsy. Although the carcinoma originated near the base of the polyp, there was no evidence that the latter had undergone malignant alteration. The two lesions in this case were considered to be entirely unrelated. Two photomicrographs and a photograph illustrate the article. BENJAMINR. SHORE Cancer as a Cause of Intestinal Obstruction, A. HINTZE. Krebs und Darmverschluss, Arch. f. klin. Chir. 183: 482-539, 1935. Cancer ranks second to benign connective-tissue adhesions as a cause of intestinal obstruction. Most often the obstruction is due to occlusion of the lumen by an in- 610 ABSTRACTS trinsic primary growth, but in rare instances it may be caused by neoplastic adhesions, metastatic growths, or pressure from lesions outside the intestinal tract. From 1909 to 1933, 91 cases of intestinal obstruction due to malignant tumors were observed in the University Clinic in Berlin. There were 87 carcinomas and 4 sarcomas. In the 70 cases in which the obstruction was caused directly by the primary growth, operation was performed 68 times; there were 28 resections, 4 entero-anastomoses, 35 colostomies, and one unclassified operation. Five-year cures were obtained in 10 or 35.7 per cent of the 28 cases in which the growth was resected. The sigmoid was the site of the primary growth in 30 cases, the ileocecal region in 8, the ascending colon in 1, the hepatic flexure in 2, the transverse colon in 4, the splenic flexure in 3, the rectum in 19, and the small intestine in 1 case. Carcinomas arising outside the intestinal tract, usually in the uterus and ovaries, caused obstruction in 16 cases, while metastatic growths from the stomach and breast caused obstruction in 6 cases. The article is illustrated with roentgenograms and drawings. Fifty-one of the cases studied are included in tabular form. BENJAMINR. SHORE

Ileo-ileal Intussusception by a Sarcoma of the Small Intestine, R. CROUSSEAND F. GILLET. Invagination ilCo-ilCale par tumeur sarcomateuse du gri"le, Ann. d. 1'Inst. chir. de Bruxelles 37: 1-5, 1936. In the right hypochondrium of a thirty-two-year-old man an ileo-ileal intussusception was discovered, caused by leiomyosarcoma. The tumor measured 6 by 9 cm. and was pedunculated. Eighty centimeters of intestine were resected to relieve the obstruction, but with fatal outcome. Three photographs of the tumor are included. A few references are given. CHARLESA. WALTMAN

Relationship between Adenomata and Cancer of the Large Bowel, J. P. LOCKHART- MUMMERY. Lancet 1: 1149-1151, 1935. Lockhart-Mummery studied the after-histories of 50 patients who had been operated on for simple, so-called innocent adenomata of the rectum and colon with a view to dis- covering the number and location of recurrences. Only those cases were included in which the original adenoma was adequately removed according to modern standards and in which the patient was followed for at least a year. In 25 of these cases one or more tumors subsequently developed and in 12 instances malignant tumors occurred. Jn view of this the author believes he is justified in con- cluding that adenomata of the bowel epithelium are not in any sense innocent but are merely a stage'in the development of cancer. Mere removal of a rectal adenoma, therefore, would appear to be insufficient to prevent the future occurrence of adenoma or even carcinoma. Since, however, radical removal of the rectum is seldom possible, the best course is to keep the patient under regular observation and to remove by the cautery or by fuming nitric acid any secondary tumor that appears. As adenomata appear not to undergo malignant change until a certain size is attained, this procedure should afford protection for many years. In only one of 50 cases so treated did the patient develop a malignant tumor, and in that one case the innocent tumor was in the rectum and the secondary one, which became malignant, occurred in the pelvic colon out of reach of the sigmoidoscope. [An admirable monograph covering this subject, which should be read by all inter- ested, is Westhues' Die pathologisch-anatomischen Grundlagen der Chirurgie des Rektumkarzinonis, published by G. Thieme, Leipzig.]

Case of Adenocarcinoma of the Sigmoid with Lymphatic Leukemia Blood Picture, CARLREICH. Am. J. Cancer 26: 781-782, 1936. Report of a case with autopsy findings.

Resection for Carcinoma of the Sigmoid and Sigmoid Rectum, D. P. MACGUIRE. Clin. Med. & Surg. 42: 346-347, 1935. 'This is a short discussion of the radical surgical removal of carcinomas of the sigmoid and sigmoid rectum. A one-stage procedure is used after a preliminary cecostomy. THE LIVER 61 1

The so-called aseptic technics, utilizing various forms of clamps, are misnomers, since the trauma applied to the bowel is quite sufficient to cause much of the peritonitis which occurs in these cases. [See following abstract.] BENJAMINR. SHORE

Resection for Carcinoma of the Sigmoid and Sigmoid Rectum, D. P. MACGUIRE. Lancet 2: 1114-1116, 1935. MacGuire describes a technic for the resection of carcinoma of the sigmoid and rectosigmoid which dispenses with the use of clamps across the lumen of the bowel. The colon is not severed by cautery intraperitoneally nor is the colon wall sutured to the parietal wall of the peritoneum. In a subsequent letter to the journal (p. 1207) Lockhart-Mummery described the procedure as clumsy and unnecessarily complicated, with nothing to recommend it. He says: “ An operation that must of necessity be performed upon an elderly patient, since cancer of the rectum is usually met with in patients between the ages of fifty-five and sixty-five, must, to be successful, be as simple and as quick as is reasonablv possible, and an operation which inevitably involves opening the abdomen three times (twice through one incision and once through another), and also opening the pelvis from the perineum, cannot, it seems to me, recommend itself to modern surgeons, and is not one to be copied.”

Pseudomyxoma Peritonei, T. ANTOINE. Zur Frage des Pseudomyxoma peritonei, Ztschr. f. Geburtsh. u. Gynak. 111: 37-53, 1935. Pseudomyxoma peritonei can originate from the appendix or ovary, and in many cases a dual origin seems highly probable. Extension of the myxomatous material into the surrounding connective tissue is the result of pressure and not of active cell proliferation. The therapy consists in the removal of both ovaries and appendix in every case and postoperative roentgen irradiation. The histories of seven patients are reported. Only two are still living at the time of this report, one six months, and one two years after operation. Six photomicrographs illustrate the article. BENJAMINR. SHORE

THE PANCREAS

Carcinoma of the Pancreas with Cardiac and Cutaneous Metastases, Case Report, M. E. MARTENAND LEO M. MEYER. Am. J. Cancer 27: 106-110, 1936. A report, with autopsy findings, of a primary pancreatic adenocarcinoma with widespread metastases involving the heart, liver, kidneys, adrenals, bladder, rectus abdom- inis muscle, and skin. Two photomicrographs are included.

THE LIVER

Partial Hepatectomy for Carcinoma of the Liver. Recurrence. Result Twenty Months after the First Operation, Six Months after the Second, ARMAND-DELILLE,F~VRE, AND LESTOCQUOY.Epithelioma du foie trait6 par hkpatectomie partielle. RCcidive ganglionnaire et ablation du ganglion int6ressC. Ritsultat vingt mois aprks la premihre intervention, six mois aprhs la second, Bull. SOC.de pbdiat. de Paris 33: 480-484, 1935. This is the further history of a case reported in the Bull. SOC.de pbdiat. de Paris 32: 292, 1934 (Abst. in Am. J. Cancer 23: 893, 1935). The child was first operated on for carcinoma of the liver. She remained in good health after the operation, but fourteen months later a mass was palpable in the abdomen. No pulmonary metastases were demonstrable. At exploration a tumor about the size of an egg was found in the gastro- colic omentum. It was removed, together with a small node from the region of the greater curvature of the stomach. The former specimen contained metastases whereas the latter did not contain any neoplastic tissue. Six months after the second operation the patient’s general health was excellent. There are no illustrations. CHARLESA. WALTMAN 612 ABSTRACTS

THE SUPRARENAL GLANDS

Cortical Carcinoma of the Suprarenal with Cushing’s Basophil Pituitary Syndrome, I>. C. HARE, J. M. Ross AND A. C. CROOKE. Lancet 2: 118-122, 1935. The authors report in detail a case of carcinoma of the suprarenal cortex presenting the clinical features of Cushing’s basophil pituitary syndrome. The patient was an unmarried woman, twenty-nine years of age at the onset of symptoms. The chief features in the history, which covers a period of three years, were headache and vomiting, persistent metrorrhagia followed by amenorrhea, hirsutism of the male type with loss of scalp hair, greasy skin, an acneiform eruption, striae atrophicae, and adiposity of the face, neck, shoulders, and trunk. A roentgenogram of the pituitary fossa showed it to be rather smaller than normal. An exploratory laparotomy was done and a suprarenal tumor discovered. This was removed at a subsequent operation, but the patient died of shock. The tumor measured 10 x 9 x 4 cm. and was roughly nodular. It consisted for the most part of white tissue similar in structure to that described for cortical carcinoma. Red areas consisting of columns of large polyhedral cells were present. Small fuchsino- phi1 granules were demonstrable. Metastatic nodules were found in the liver, lungs, and mediastinal lymph nodes. The pituitary was slightly larger than normal owing to a large accumulation of colloid in the pars intermedia. The differential cell count showed normal percentages of chromophobe, acidophil and basophil cells, but the basophil cells of the anterior lobe showed a conspicuous change, the normal granular cytoplasm being replaced to various degrees by dense homogeneous hyaline cytoplasm. Photographs of the patient show strikingly the progressive change to masculine type. Photographs of the tumor are also included, but no photomicrographs. [In connection with this report see Lescher and Robb-Smith: Proc. Roy. SOC.Med. 27: 404, 1934, abst. in Am. J. Cancer 22: 717, 1934; Crooke: J. Path. & Bact. 41: 339, 1935, ahst. in Am. J. Cancer 27: 408, 1936; Calder and Porro, abst. below.] Adenoma of Adrenal Cortex Simulating Pituitary Basophilism (Cushing’s Syndrome), R. A/[. CALDEKAND F. 1%’.PORRO. Bull. Johns Hopkins Hosp. 57: 99-110, 1935. A case report of a thirty-four-year-old woman in whom a rapidly acquired plethoric obesity, hypertrichosis, amenorrhea, hypertrophy of the clitoris, generalized osteoporosis, vascular hypertension, and moderate polycythemia led to the clinical diagnosis of a basophilic adenoma of the pituitary gland. At autopsy a well defined tumor 15 x 20 x 5 cm. was found, arising in the left adrenal gland. The pituitary gland was normal. IIistologic study of the adrenal growth showed it to have the structure of normal cortex. In the present state of our knowledge, differential diagnosis between pituitary basophilism and primary adenocortical lesions is difficult, if not impossible. Perhaps the most helpful differential feature is hypertrophy of the genitalia. This sign is frequently present in adrenal neoplasms but has never been seen in the cases of pituitary basophilism so far reported. The article is illustrated with photographs of the patient before and after the onset of her disease, photographs of the osteoporotic bones, and one photomicrograph. BENJAMIN R. SHORE

Carcinoma of the Adrenal Cortex, L. BABONNEIX, DELARUE,I,. GoLIO, AND JOURDAN. F’pithblioma cortico-surrhal chez line jeuiie fille de treize ans et demi, Bull. SOC.de pCdiat. de Paris 33: 258-262, 1935. ‘I‘his is a clinical pathological report of a girl aged thirteen and a half years, who died of a tumor involving the lungs, liver, and peritoneal cavity. A large tumor was attached to the right kidney. The left adrenal appeared normal but the right was not found. The histology of the metastases suggested carcinoma of the adrenal cortex. No photomicrographs are included and there is no bibliography. CHARLESA. n’A1,TMAN

Cystic Lymphangioma of the Adrenal Gland, M. [I‘INTER. Lymphangioma cysticum dcr Nebenniere, Centralbl. f. allg. Path. u. path. Anat. 63: 30.5-308, 1935. A multilocular cyst measuring 5.8 x 3.5 x 3.5 cm. was found in the left adrenal gland of a thirty-six-year-old woman. Histologic study showed the cysts to be lined in places THE FEMALE GENITAL TRACT 61 3 with endothelium. The diagnosis was multiloculated cystic lymphangioma. One photograph and one photomicrograph illustrate the report. BENJAMINR. SHORE

THE FEMALE GENITAL TRACT

Correlation Between the Histology, Prognosis, and Therapy of Female Genital Carci- nomas, P. FELDWEG.Beziehungen zwischen Histologie, Prognose und Therapie des Cenitalkarzinoms, Ztschr. f. Geburtsh. u. Gynak. 111: 1-25, 1935. Four hundred and twenty-two cases of carcinoma of the uterus, vagina, and vulva seen in the Woman’s Clinic in Stuttgart from 1914 to 1927 were studied to determine the relation of the histologic structure to prognosis and treatment. The growths were divided into three groups: (1) definitely squamous tumors; (2) definitely adenomatous tumors; (3) an intermediate group composed of partly squamous and partly adenomatous tissue. There were 284 squamous-cell carcinomas, 103 adenocarcinomas, 9 carcinomas of the mixed type, and 26 completely undifferentiated growths. Of 287 carcinomas of the cervix, only 28 were adenocarcinomas, while of 81 carcinomas of the body of the uterus 74 were adenomatous. Differentiation of the tumors increased in direct proportion to the age of the patient. One hundred of the 422 patients were treated by operation and irradiation, while the remaining 322 were treated by irradiation alone. Cures of an unstated length of time were obtained in 22.2 per cent of the squamous-cell carcinomas of the cervix; in 10.7 per cent of the adenocarcinomas; in 16 per cent of the totally undifferentiated tumors; and in none of the combined squamous and adenomatous growths. On the contrary, about the same number of cures were obtained for all these types of tumors when they occurred in the body of the uterus: there were 43 per cent of cures for the squamous tumors; 40.6 per cent for the adenocarcinomas; 40 per cent for the mixed group; and no cures in the completely undifferentiated growths. The number of mitoses present in a given tumor is a good indication of its malignancy. Better results, however, were obtained in the treatment of tumors with a moderate number of mitoses than of those with very few mitotic figures. A study of the supporting connective-tissue framework led to the conclusion that the prognosis was better in growths showing an active inflammatory reaction. The article is illustrated with photomicrographs. BENJAMINR. SHORE

Female Sex Hormone and the Tumor Problem, J. HOFBAUER.Weibliche Sexualhor- mone und das Tumorproblem, Zentralbl. f. Gynak. 59: 2534-2536, 1935. Some of the recent work concerning the influence of ovarian and pituitary stimulation on the epithelium of the breast and uterus is discussed. The author considers that this work substantiates his original belief that the changes observed in the uterine cervix are due to the sexual hormones and not to different phases of the normal cycle. There are no illustrations. BENJAMINR. SHORE

Excretion of Anterior Pituitary Hormone in Women with Genital Carcinomas, 0. BUSSEAND KLEHMET. Hypophysenvorderlappenhorrnon-Ausscheidung beim Geni- talkarzinom der Frau, Zentralbl. f. Gynak. 59: 7-9, 1935. Anterior pituitary hormone was demonstrated in the urine in 19 of 30 patients with carcinomas of the uterus and vagina. Seventeen of these 19 patients had passed the menopause, while one had had an artificial menopause produced by irradiation. The urine from 11 of the entire group of 30 patients failed to show the anterior pituitary hormone; 9 of these patients were menstruating regularly and 2 were nursing children. The reaction, therefore, in patients with active or potentially active ovaries and carcinoma was 100 per cent negative. It was concluded, therefore, that the presence of anterior pituitary hormone in the urine of patients with uterine carcinoma is dependent upon whether or not the normal ovarian cycle is being maintained. BENJAMINR. SHORE 614 ABSTRACTS

Aschheim-Zondek Reaction in Cancer of the Female Genitalia, P. NATALE. Sulla reazione I di Aschheim-Zondek nel cancro genitale femminile, Ann. di ostet. e ginec. 57: 1171-1177, 1935. Natale performed the Aschheim-Zondek test on urine which had not been concen- trated, from ten women with cancer of the genitalia. In one case of carcinoma of the cervix he got a positive reaction, but the other cases were negative. He then used Zondek's " rapid " method of concentrating the urine and tested 18 additional cases. Hy this method he obtained 5, or 27.7 per cent, positive reactions. These positive reactions were obtained in one cervical carcinoma, two corpus carcinomas, one carcinoma of the vulva, and one carcinoma of the vagina. Natale concludes that the Aschheim-Zondek test certainly has no diagnostic value it1 carcinoma of the female genitalia. C. D. HAAGENSEN Characteristics of the Cerebrospinal Fluid in Cases of Carcinoma of the Female Geni- talia, A. MASHBITZAND MAZKEVITSCH.Uber das Verhalten des Liquor cerebro- spinalis beim Krebs der weiblichen Genitalorgane, Zentralbl. f. Gynak. 59: 577-581, 1935. The sugar and lactic acid content of the cerebrospinal fluid was studied in 16 patients with known carcinoma of the female genital tract and 6 control cases. In the majority of the carcinoma cases there was an increase in the lactic acid content of the cerebrospinal fluid; the sugar curve remained normal. The increase in the lactic acid was interpreted as being due to the increased metabolism occurring in malignant tumors. BENJAMINR. SHORE Importance of Colposcopy for Cancer Research, H. ROGGE. Die Bedeutung der Kol- poskopie fur die Krebsforschung, Monatschr. f. Geburtsh. u. Gynak. 100: 135-137, 1935. 'The author believes that colposcopy according to the method of Hinselmann will aid in the investigation of the etiology of cancer. He does not present any cases or pathological material to show how this may be accomplished, but confines his statements to general remarks. There is no bibliography. CHARLESA. WALTMAN Causes of Delay in the Treatment of Cancer of the Female Genitalia, R. LEVENSON. Cause di ritardo nella cura del cancro dei genitali femminili, Ann. di ostet. e ginec. 57: 875-886, 1935. Levenson has analyzed the causes of delay in treatment which were found in a series of 894 cases of cancer of the female genitalia coming to the gynecological division of the Cancer Institute of the University of Milan between the years 1928 and 1933. In 54.9 per cent of the cases the disease was so far advanced as to be classed as inoperable when the patient first presented herself for treatment. The average length of time intervening between the appearance of symptoms and the first consultation was four months. This delay in seeking medical advice was explained as due to ignorance in 46.9 per cent of the patients, to procrastination in 22.6 per cent, to fear in 19.8 per cent, and to other causes in 10.5 per cent. Fifty-five per cent of the women first consulted their family physicians, who made the correct diagnosis in 70 per cent of them. Twenty-four per cent of the patients first consulted a specialist in women's diseases, who made the correct diagnosis in 90 per cent. I.I hree per cent of the patients first consulted a midwife, who made the correct diagnosis in 40 per cent. In 78 per cent of the patients treatment was instituted at once. In 13 per cent there was a delay of less than a month. In another 9 per cent there was a delay of from several months to a year. C. D. HAAGENSEN Treatment of Female Genital Carcinomas by Irradiation, S. SIMON.Dauerergebnisse der Strahlenbehandlung von Karzinomen des weiblichen Genitales, Zentralbl. f. Gynak. 59: 11-19, 1935. Iluring the three-year period 1926-1928, 298 patients with carcinoma of the uterine cervix were treated in the first University Woman's Clinic in Vienna. One hundred and THE FEMALE GENITAL TRACT 61 5 forty-seven, or 49.1 per cent, were operated on, and 120, or 40.2 per cent, were irradiated. Four of ten patients with less advanced growths belonging to groups I and 11, and 14, or 12.7 per cent, of 110 patients with advanced growths belonging to groups 111 and IV survived five years following irradiation. Thirty-one, or 10.4 per cent, received no form of radical treatment. The absolute rate of curability was 15 per cent. Of 40 patients with carcinomas of the body of the uterus 29 were operated upon, and 23 of these were irradiated afterwards. Nineteen or 65 per cent of these patients are well after five years and one is living with recurrences. Eleven patients were irradiated primarily and 3 of these are living. BENJAMINR. SHORE

Value of Carcinoma Reactions in the Early Diagnosis of Uterine Cancers, H. B~LOHRAD- SK+. Ueber den Wert einiger Karzinom-Reaktionen als Methoden zur Fruhdiag- nostik des Uteruskrebses, Wen. klin. Wchnschr. 48: 1612-1615, 1935. Tests described by Roffo, Botelho, Kahn, Fischer, Fonio, Bock, Fuchs, Lintz, and Davis, for the early diagnosis of cancer were done on 37 known cases of cancer and 14 control non-cancerous cases. It was concluded from this study that these tests could not be relied on and that physical examination and histologic study of biopsy specimens were the only reliable means of diagnosis of cancer. BENJAMINR. SHORE

Carcinoma of the Cervix in Young Women, G. DODERLEIN. Das Kollumkarzinom bei jungen Frauen, Zentralbl. f. Gynak. 59: 587-591, 1935. Also in Ztschr. f. Geburtsh. u. Gynak. 110: 349-353, 1935. From 1914 to 1928, 932 patients with carcinoma of the cervix were seen in the Uni- versity R'oman's Clinic in Munich. Of this number, 48, or 5.15 per cent, were under thirty years of age. In this latter group, 44 or 92 per cent of the growths were operable. Forty-one patients had radical Wertheim operations without preoperative irradiation; two had radical Wertheim operations with preoperative radium irradiation ; one had a radical vaginal operation without preoperative irradiation; and four patients with inoperable growths received irradiation. These last four patients died from three to ten months later. Twenty-three or 48 per cent of the entire group of patients were living and well from six to twenty years after the institution of treatment. Considering only the 44 patients operated on, there was a relative five-year curability rate of 52.3 per cent. BENJAMINR. SHORE

Factor of Birth Trauma in Cancer of the Uterine Cervix, CATHERINEMACFARLANE. Am. J. Obst. & Gynec. 30: 133-135, 1935. Also in Med. Woman's J. 42: 259-261, 1935. In an effort to obtain reliable statistics on the relative incidence of carcinoma of the cervix in nulliparous as compared to parous women, the author studied the records of 4000 admissions to two hospitals, comprising 1000 single white nulliparous women, 1000 married white nulliparous women, 1000 married white parous women and 1000 married colored women. The accompanying table shows the incidence of carcinoma

Total Carcinoma Carcinoma carcin- No. of cases Age of cervix of body oma of uterus

1000 Single, white nulliparous 2 7-7 7 3 (3)* 6 20 26 1000 Married, white nulliparous 20-79 7 (7)* 14 10 24 1000 Married, white parous 20-79 37 9 46 1000 Married, black parous 20-75 28 (14)* 42 1 (1)* 2 44 616 ABSTRACTS of the cervix and carcinoma of the fundus in these groups. It appears that latior (or pregnancy) increases the probability of cancer of the cervix three-fold. Believing that the principal underlying cause for the higher incidence in parous women is the cervical laceration, the author makes a special plea for early repair of the after effects of 1, i r t h trauma . [It would be interesting to know how many instances of carcinoma of the uterus would be found in 1000 women who had had one or more cesarean sections without any normal delivery. Such a figure might throw some light on the discussion as to the relative importance of birth trauma as compared to endogenous factors in the causation of higher incidence of cancer in parous women.] JOHN S. LOCKWOOD

Superficial Vaginal Extension of Cervical Carcinomas, H. E. EICHENBERG.Ober- fliichliche Ausbreitung des Kollumkarzinoms auf die Vagina, Ztschr. f. Geburtsh. u. Gyn3k. 111: 243-263, 1935. Residual or recurrent carcinomas involving the vaginal wall and vulva in patients with carcinoma of the cervix may be superficial in character and relatively benign. They appear as red, eroded areas not unlike those sometimes seen following radium irradiation. There may be no induration and the diagnosis can be made only by histologic examination of suspicious areas. It is recommended that radical operation be employed for all carcinomas of the cervix without parametrial involvement in order to eliminate as far as possible recurrent carcinoma of the vagina. The article is illustrated with photomicrographs, photographs, and drawings. BENJAMINR. SHORE

Early Diagnosis and Treatment of Carcinoma of the Cervix, H. MARTIUS. Fruherken- nung und Behandlung des Gebarmutterhalskarzinoms, Med. Klin. 31 : 1385-1390. 1935. Martius reviews the causes of delay in making an early diagnosis of carcinoma of the rervix. He advocates the Wertheim operation with postoperative radiotherapy for operable cases but no examples are reported and only a few references to the literature are given. The author claims that 64 per cent of the cases treated by operation and postoperative radiotherapy during 1922-1926 were five-year cures. A graph to show the age distribution of cancer of the cervix is included. CHARLESA. WALTMAN

Cancer of the Cervix-Its Prevention and Treatment, G. L. CARRINGTON.South. bled. CL Surg. 97: 556-559, 1935. Cancer of the cervix uteri is practically always preceded by erosion, a laceration with eversion, cervicitis, or retention cyst in the glands of the cervix, and can be almost entirely prevented by repair or cauterization of the diseased tissue. It is best treated by radium, usually in conjunction with x-rays. Twenty to twenty-five per cent five- year cures can be obtained for all cases and 50 to 80 per cent for early cases. Aside from the cures effected by radium treatment, about two-thirds of the badly ulcerated and extensive local lesions will heal, so that the patient, although not cured, will be relieved of bleeding and foul discharge. BENJAMINR. SHORE

Radium and Roentgen Rays in the Treatment of Cancer of the Cervix, A. RATTI. II trattamento col radio e coi raggi X del cancro del collo dell’ utero, Rass. internaz. d. chi. e terap. 16: 499-516, 1935. At the cancer institute of the University of Milan radium is the main reliance in the treatment of carcinoma of the cervix, although roentgen rays are used as a supplementary weapon. The radium must be applied to suit each particular case, but on the average three tubes, each containing 10 mg. of radium filtered by from 1 to 2 mm. of platinum are used. They are sheathed in rubber tubing and one is inserted into the cervix and one placed vertically in each fornix. The tubes are taken out every two or three days, the vagina cleansed, and the radium replaced. The treatment lasts from right to ten days, a total of from 6000 to 8000 milligram hours being given. From five to seven weeks after the radium treatment is completed a Coutard series THE FEMALE GENITAL TRACT 617 of roentgen ray treatments is given. Ratti does not include the details of the roentgen therapy given at Milan. This type of treatment has given, in a series of 177 cases of cervical carcinoma treated at the institute, an absolute cure rate of 20.3 per cent. C. D. HAAGENSEN

Radiotherapy and Complicating Infections in Cancer of the Cervix, P. DESAIVE. Con- sidkrations sur la radiothkrapie des cancers du col utCrin et sur les complications infectieuses de ce traitement, Le cancer 11: 21.3-230, 1934. The development of complicating infections during the treatment of cancer of the cervix with radium may be fought by cleansing the field with suitable fluids, removing projecting portions of the growth by electrocoagulation, 6y the general or local administration of appropriate serums or vaccines, chemotherapy, careful radiation technic which will avoid traumatism as much as possible and, finally, by general supportive measures. Curative treatment depends upon the extent of the infection. In simple cases the temporary suspension of radiation will suffice. Where the cbndition is more advanced general measures are indicated, such as transfusion with blood of high bactericidal value and the intravenous injection of hypertonic sodium chloride solution. Surgical intervention may become necessary for the evacuation of pus, or even salpingectomy or supravaginal hysterectomy. If repeated infections occur, curietherapy may have to be given up in favor of deep roentgen therapy or telecurietherapy. The ideal treatment for cervical carcinoma is still a matter of dispute. When the figures published by 26 authors for the period 1904-1929 are averaged, the following results emerge. In operable cases surgery alone gave 22.4 per cent of five-year cures. For a combination of operable and inoperable cases radiotherapy alone gave 24.3 per cent of six-year cures. Radiotherapy would thus appear to be the method of choice, for entirely apart from these remote results its immediate mortality is but 1-3 per cent as compared with the 4-19 per cent which must be charged against surgery. While admitting the possible value of some happy combination of radiotherapy and surgery, the author prefers at present radiotherapy, which in his own hands has yielded 20 per cent of five-year cures, a figure which approaches very closely the average just given. Like most radiotherap- eutists he believes that still better results will be reported for the next five-year period, thanks to the continual progress that is being made in technic. WM. 13. WOGLOM

Pregnancy Complicated by Carcinoma of the Cervix, W. NEILL, JR. Am. J. Obst. & Gynec. 30: 414-419, 1935. In the author’s opinion the treatment of choice for cervical carcinoma in pregnancy is radiation, not radical operation which in the past has yielded high mortality, maternal as well as fetal, and poor immediate results. In cases diagnosed during the first four months of pregnancy, Neil1 employs 2 or 3 grams of radium against the growth for one to one and one-half hours, followed by therapeutic abortion unless this occurs spontaneously. If the disease is encountered later in the pregnancy the topical application of radium is made in the same way, but the pregnancy is allowed to continue to term when cesarean section is done. Supplementary treatment may be given after termina- tion of the pregnancy. Of the author’s 6 patients, 2 have been alive and well for more than four years, with normal children in both cases. In the other 4 cases death occurred from persistent disease, but in 3 of them normal children were obtained. JOHN S. I,OCKWOOU Autotransplantation of the Ovary at the Time of Operation on Carcinomas of the Uterine Cervix, G. TUMANOFF.Zur Autotransplantation des Eierstockes bei der Operation des Collumkarzinoms, Zentralbl. f. Gyn&k. 59: 2311-2312, 1935. In order to conserve ovarian tissue in young individuals at the time of radical operations for carcinoma of the uterine cervix, the author suggests transplanting the right ovary with its blood supply through the suspensory ligament on to the lateral side of the ascending colon. He reports the case of a twenty-six-year-old woman who has had no menopausal symptoms for two years following this procedure. The technic places the 61 8 ABSTRACTS ovarian tissue outside the field of any postoperative irradiation which may be given and is thought to be superior to transplantation of ovarian tissue into the breast. BENJAMINR. SHORE

Concerning Leukoplakia of the Cervix, E. BARSONYAND A. KovAcs. uber leukoplakie der Portio Vaginalis Uteri, Acta cancrol. Vol. 1, No. 2: 19-36, 1934. Two cases are described in which leukoplakia and carcinoma of the cervix coexisted. The authors believe that the leukoplakia antedated the carcinoma, and they attempt to trace histologically the transition from the former to the latter. Six photomicrographs are included. C. D. HAAGENSEN

Cancer of Cervix and Vagina in a Case of Complete Procidentia, L. BRADY. Am. J. Obst. & Gynec. 30: 277-280, 1935. In this article is reported the only instance of carcinoma of the prolapsed cervix in the files of the Johns Hopkins Hospital. The patient was a woman of sixty-five who had had procidentia for fifteen years. She developed a malignant ulcer 4 x 3 cm. on the external 0s and a second lesion 6x5 cm. in size on the prolapsed vaginal wall. Radical vaginal hysterectomy was performed with satisfactory immediate postoperative course. Brady reviews the literature and finds that the recent report of Emmert and Taussig (Am. J. Obst. & Gynec. 28: 521, 1934. Abst. in Am. J. Cancer 24: 463, 1935) is conspicuous in being the only one of many in the literature on the subject tending to indicate that prolapsed uteri are prone to develop carcinoma. All other writers have been impressed with the extreme rarity of this lesion. There is one illustrative drawing and a comprehensive bibliography. JOHN S. LOCKWOOD

Primary Carcinoma of the Cervix Followed by a Primary Breast Carcinoma, H. HELLEN- DALL. Primares Portiokarzinom und spateres primares Mammakarzinom, Zentralbl. f. Gynak. 59: 2554-2560, 1935. A primary squamous-cell epithelioma of the cervix uteri treated by radical surgery was followed in five years and seven months by a mammary gland carcinoma of the right breast. Histologic study of the two growths showed them to be unrelated. There are no illustrations. BENJAMINR. SHORE

Carcinomatous Cyst of the Uterus, H. E. EICHENBERG.Karzinomatose Uteruscyste, Zentralbl. f. Gynak. 59: 1686-1689, 1935. The case is reported of a sixty-eight-year-old woman on whom a supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed, supposedly for a myoma of the uterus. Study of the specimen showed an intramural cyst containing thin brown fluid situated in the fundus of the uterus. The lining was composed of several layers of cuboidal epithelium which had a definite tendency towards proliferation and secondary cyst formation. The lymphatic vessels several millimeters away from the cyst were filled with epithelial cells and the surrounding hterine muscle was infiltrated with adenocarcinoma. In spite of postoperative roentgen irradiation, a recurrence developed in the uterine stump and a metastasis could be felt in the lower part of the abdomen. Histologic study of a biopsy specimen removed from the cervical growth showed it to be a papillary adenocarcinoma. Three photomicrographs illustrate the article. BENJAMINR. SHORE

Total versus Subtotal Hysterectomy in Benign Uterine Disease, E. H. RICHARDSON. Am. J. Obst. & Gynec. 30: 237-243, 1935. Richardson is not inclined to advocate routine subtotal hysterectomy for benign uterine conditions in spite of the increasing frequency of reports of carcinoma developing in the cervical stump. There is no evidence among the cases reported that the cervices were treated prophylactically in such a way as to reduce the probability of cancer formation. In general, the mortality from the total hysterectomy will be sufficiently greater than for the subtotal operation to offset the theoretical advantage of the former operation. However, surgeons should be prepared to perform the more radical opera- 630 ABSTRACTS

Voluminous Tumor of the Spermatic Cord, P. LEGAC. Volumineuse tumeur du cordon spermatique, Bull. et mkm. SOC.de mCd. de Paris 139: 371-373, 1935. A man fifty-six years old was seen with an enormous tumor of the right spermatic cord which had been growing for about two years. The tumor was the size of an infant's head, painless, lobulated, firm, non-tender, and not adherent to the skin. The penis had disappeared as if absorbed by the growth. At operation it was found necessary to remove the tumor, cord, and right testicle en bloc, the entire mass measuring 16 x 21 cm. and weighing 1500 gm. On section the tumor had the appearance of a fibroma but microscopically showed connective tissue, smooth muscle, and fat cells, all without evidence of malignancy; a diagnosis of fibromyolipoma of the spermatic cord was made. Two sketches of the specimen are given. There is no bibliography. THEODOREP. EBERHARD

THE NERVOUS SYSTEM

Intracranial Tumors: a Synopsis, C. WORSTER-DROUGHT.M. Press & Circular 190: 434-438, 1935. 'This is a discussion of the diagnosis and treatment of intracranial tumors based upon the following classifications: (1) those tumors which affect a particular organ, such as the pituitary gland, acoustic nerve, choroid plexus, and pineal gland; (2) those which may affect any region of the brain, such as various types of glioma, meningiomas, and metastatic tumors. There are no illustrations. BENJAMINR. SHORE

Intracranial Tumors of Infancy and Childhood, P. BAILEY. Am. J. Dis. Children 48: 1163-1166, 1934. Brain tumors are of many varieties and cannot profitably be considered as a whole. Those occurring in children are different pathologically from those occurring in adults and have a different location. About 70 per cent of the brain tumors occurring in patients under fifteen years of age are subtentorial [posterior fossa, cerebellar] tumors. Of these, the three most common pathological types are the astrocytoma, the medul- loblastoma, and the ependymoma. The most common supratentorial tumor is the craniopharyngioma. The general signs of tumor, i.e. those due to increased intracranial pressure, are much like those of adult patients except that they may be less severe owing to separation of the cranial sutures. With posterior fossa tumors in children vomiting is a very early and common symptom. It is caused by direct pressure upon the vomiting mechanism of the brain stem. Children with posterior fossa tumor may show few or no symptoms except some stiffness and discomfort of the neck muscles. Abnormal attitudes of the head and neck may occur. The ependymoma is typical of the fourth ventricle tumors. The tumors of the cerebellum proper are about equally divided between the benign, often cystic astrocytomas and the soft, highly malignant medulloblastomas. The suprasellar craniopharyngioma shows sufficient calcification to be recognized in the x-ray films in about 85 per cent of the cases. The craniopharyngioma must be distinguished from the less common glioma of the optic chiasm. The latter lesion often produces dilatation of an optic foramen, sufficient to be recognized in the x-ray films. Such patients often show clinical evidence of generalized neurofibromatosis. Other rare tumors in the supratentorial region in children are the pinealoma, papilloma of the choroid plexus, teratoma, sarcoma, and the angiomas. The latter may sometimes be suggested by the occurrence of a facial nevus. Brain tumors in children not uncommonly reach an enormous size before causing recognizable neurological signs. Tuberculoma of the brain, except in the negro, is a rare lesion in this country. In other countries it is much more frequent. EDWINM. DEERY

Torsion of the Vagina by a Fibroid Uterus, G. JEANNENEY. Torsion axiale aigue du fond du vagin par uttrus fibromateux, Gaz. hebd. d. sc. mCd. de Bordeaux 56: 66-67, 1935. Also in J. de mCd. de Bordeaux 112: 275-276, 193.5. A patient with acute abdominal pain was found to have a large fibroid uterus weighing 7.5 kg. and measuring 29 by 15 cm. The uterus had been completely twisted around, thus causing a torsion of the vagina. There is a gross photograph of the tumor and a short bibliography is appended. CHARLESA. WALTMAN

Operative Treatment of DifAcult Adnexal Tumors, 0. WOLF. Die Klinik der operativ behandelten schweren Adnextumoren, Monatschr. f. Geburtsh. u. Cynak. 100: 41-56, 1935. This article concerns chiefly tumors of an inflammatory nature and considers neoplasms only in so far as they may be secondarily infected. CHARLESA. WALTMAN

Importance of Gonadotropic Hormones in the Diagnosis of Chorionepitheliomas, E. ENGELHART.Die Bedeutung des gonadotropen Hormonnachweises fur die Diagnose des Chorionepithelioms und dessen Dauerheilung, Zentralbl. f. Gynak. 59: 2730- 2737, 1935. Ihring the last ten years, 13 hydatid moles and 5 malignant chorionepitheliomas were observed in 25,561 pregnancies in the IJniversity Woman’s Clinic in Graz. ’I‘he case is reported of a thirty-one-year-old woman in whom the diagnosis of a maliguant chorionepithelioma was made by histologic study following curettage after a spontaneous miscarriage. I3ecause of a persisting positive Friedman test, the uterus and right tube and ovary were removed. Histologic study showed a residual tumor in the left cornu of the uterus. The Friedman test was negative fourteen days after the operation and has remained so for one year. The patient is therefore considered cured. One photograph and one photomicrograph illustrate the article. BENJAMINR. SHORE

Ectopic Chorionepithelioma, E. PHILIPP. Ein ektopisches Chorionepitheliom, Zentralbl. f. Gynak. 59: 2-7, 1935. A twenty-two-year-old woman had been delivered of full-term infants in 1931 and 1933. Menstruation did not return during the nine months for which the second child was nursed, but after this it was profuse and the periods were prolonged. Beneficial results were obtained by the administration of ovarian preparations. In November 1934, a tumor was palpated in the right parametrium. At operation, a hemorrhagic mass, situated to the right of the cervix, was removed with the uterus. The ovaries were not removed. Histologic study of the tumor showed typical chorionepithelioma. An Aschheim-Zondek test done the day after operation was strongly positive; it had become negative eleven days later. Postoperative roentgen and radium irradiation were given but the end-result is not recorded. Several photomicrographs illustrate the article. BENJAMINR. SHORE

Angiofibroma of the Placenta, R. M. BKONSTEIN.Uber das Angiofibrom der Plazenta, Monatschr. f. Geburtsh. u. Gynak. 100: 261-264, 1935. According to the author this is the fifth case of angiofibroma of the placenta reported in the literature. Following a normal delivery of a normal child a tumor measuring 7.5 x 9 x 4 cm. was discovered in the center of the placenta on its fetal surface. On the maternal surface infarcts were especially noticeable in the region of the tumor. Microscopically, the tumor showed many areas of necrosis with calcification. The connective-tissue growth contained many thin-walled, blood-filled capillaries. There are no photomicrographs. A short bibliography is included. CHARLESA. WALTMAN

Sixty Cases of Metastatic Gastro-Intestinal Carcinomas in the Ovaries, G. OPITZ. Pathologie und Klinik von 60 Fallen von gastro-enterogenem Ovarialkarzinom, Ztschr. f. Geburtsh. u. Gynak. 111: 54-67, 1935. From 1924 to 1934, 60 metastatic tumors were observed among 405 ovarian carcinomas studied in the Pathologic Institute of the University Woman’s Clinic in Berlin. THE FEMALE GENITAL TRACT 62 1

The exact site of the primary tumor was proved by operation in 11 cases, by roentgenographic examination in 6 cases, and by autopsy in 5 cases. The stomach was the site of the growth in 18 cases, the intestine in 3 cases, and the gallbladder in one case. In 28 of the remaining cases examination of the patient and histologic study of the metastatic tumor made it fairly certain that the primary tumor was in the stomach or intestinal tract. In the remaining 10 cases the diagnosis of gastro-intestinal tumor was made upon the histologic structure of the ovarian growths alone. Pain in the lower portion of the abdomen is a prominent symptom in these cases and probably corresponds with the rapid growth of the tumor. Eleven of the 60 patients menstruated regularly, 5 complained of dysmenorrhea, and 2 had menorrhagia. Five women had premature amenorrhea, and in 15 cases the growth occurred after the menopause. Twenty-two of the metastatic tumors were bilateral and 16 were unilateral. Signet-ring cells could be identified in every case. One photograph and one photomicrograph illustrate the article. BENJAMINR. SHORE

Unilateral Krukenberg Tumor, H. G. MULLER. Einseitiger Krukenbergtumor, Monatschr. f. Geburtsh. u. Gynak. 99:348-352, 1935. A case report of a forty-nine-year-old woman with a Krukenberg tumor of the right ovary secondary to a diffuse carcinoma of the stomach. The paper is without illustrations or bibliography. CHARLESA. WALTMAN

Malignant Epithelial Tumors of the Ovaries, L. R. PYLEAND 0. R. CLARK. J. Kansas M. SOC.36: 367-371, 1935. A brief discussion of the classification and treatment of ovarian tumor, with four case histories. W. S. MACCOMB

Rare Ovarian Tumors, Two Cases, B. TUNIS. Zwei Falle von selteneren Ovarial- tumoren, Wien. med. Wchnschr. 84: 1110-1113, 1934. The author feels that it is important that the rarer types of ovarian tumors be described in full, not only histologically, but with a complete clinical history, because as yet the number of reported cases is small and the clinical histories are scanty. He gives as a convenient, even though obviously imperfect, grouping, the following: (1) Granulosa- cell tumors, which have also been called folliculomas, folliculoid neoplasms or cylin- dromas. These occur in adult women much more frequently than in the young and give a clinical picture of either amenorrhea or metrorrhagia, with increase in the size of the uterus and breast and swelling of the endometrium. The prognosis as to life is relatively good. (2) Neoplasms described by Brenner, another name being oophoroma. These occur chiefly in the older age groups, are probably benign, and give rise to no clinical symptoms from the sexual organs. (3) Disgerminomas, which have also been called large-cell alveolar sarcoma, carcinosarcoma, embryonal carcinoma, chorio- ectodermal carcinoma, endothelioma, lymphangio-endothelioma, seminoma, solid granulosa-cell tumors, solid large cell ovarian carcinoma, and carcinoma of the ovary in young women. They occur chiefly in children and young women, and apparently have no hormonal function, though they may be accompanied by hypoplasia of the genitals, or if the genitals are normal in structure, with a diminished function of the ovaries. They may also be accompanied by hermaphroditic malformations or pseudohermaphroditic changes. The prognosis is not absolutely bad, but malignant and radio- resistant types have been reported. (4) Arrhenoblastoma, also called andreoblastoma masculinoma and tubular testicular adenoma. This occurs in young girls and causes the development of male sexual characteristics, which disappear after removal of the tumor. It is probably not malignant. Tunis reports two cases, the first in a twenty-one-year-old woman who had never menstruated. For eleven years she had had pains in and about the pelvis and for several years suffered with swelling of the abdomen and increasing pain. There was a suggestion of a pseudohermaphroditic condition accompanied by hypoplasia of the uterus and the uninvolved ovary. The tumor consisted of large cells without a distinct cell 622 ABSTRACTS

membrane and contained a moderate number of mitoses lying in close contact with each other in strands like epithelium. Mixed with the larger elements were small cells with pyknotic, deeply staining nuclei, possibly lymphocytes. There were a few areas of calcification. The author classifies this as a granulosa-cell neoplasm belonging in the same group as the seminomata of the testicle. A year after operation the patient returned with a tumor about 10 cm. in diameter in the other ovary, and a complete hysterectomy was done. The histology of the second tumor was the same as the first. There is no statement that the patient was given radiation therapy, but she has been followed for two years and when examined was found to have no demonstrable pelvic lesion and to have gained weight. The second patient was twenty-four years old, had had no children and no mis- carriages. Her first period began at sixteen, lasted eight days and was very free. Subsequently periods occurred every three weeks. No external evidence of hormonal disturbance was noted. Physical examination showed a hard, nodular tumor reaching to the umbilicus, and at laparotomy it was found that the growth originated in the left ovary. A complete hysterectomy was done and the patient received 35 x-ray treatments (the number of roentgen units is not stated). The neoplasm was composed of strands and masses of cells with large nuclei lying in a highly vascular fibrous stronia, which was infiltrated with a large number of lymphocytes. The author regards the neoplasm as a solid carcinoma of the ovary of the type of the granulosa-cell tumor. No further follow-up record is given. Three photographs of the gross material and one photomicrograph are included, but no bibliography. F. CAVERS

So-called Ovarian Disgerminomas, V. LISSOWETZKY.Zur Frage der sogenannten Disgerminome des Eierstocks, Zentralbl. f. Gyniik. 59: 1944-1952, 1935. About 60 cases of so-called ovarian disgerminomas have been reported in the literature. There are apparently three main groups: (1) those associated with hermaphrodit- ism and pseudohermaphroditism; (2) those in which genital or constitutional hypoplasia is a prominent symptom; (3) those in which the genital system is normally developed but in which there are physiologic sexual disturbances such as irregular or late menses and sterility. The tumors are solid, large-celled ovarian carcinomas, and usually arise in young individuals. Giant and epithelial cells and lymphocytes predominate histologically in these growths. They are essentially malignant in character, although in several instances early operation and irradiation have produced satisfactory results. The author reports the case of an eighteen-year-old girl with a disgerminoma of the right ovary in whom mental deterioration of the dementia praecox type was a predominant symptom. This mental change apparently began at about the time of the tumor growth, improved following the surgical removal of the tumor, and became aggravated again as recurrence took place. BENJAMINR. SHORE

Disgerminomas, 0. HAJEK. Beitrag zur Kasuistik der Disgerminome, Zentralbl. f. Gyniik. 59: 317-321, 1935. The histories of two patients with ovarian disgerminomas are reported. One was a twelve-year-old girl with a large tumor arising in the right ovary. The left ovary was apparently normal. The tumor and infantile uterus were removed surgically and a series of postoperative irradiation was given. The end-result is not stated. The second patient was a seventeen-year-old girl with a tumor of the right ovary which was adherent to the posterior pelvic wall and right ureter. The left ovary was moderately enlarged and cystic but contained no tumor. The uterus and both adnexa were removed and a series of postoperative irradiation was given. The patient remained well for twenty-three months, at the end of which time, however, a recurrent mass was palpated in the right lumbar region. The article is not illustrated. BENJAMINR. SHORE THE FEMALE GENITAL TRACT 62 3

Reply to Klaften Concerning Ovarian Disgerminomas, H. 0. KLEINE. Bemerkungen zu der Mitteilung von Klaften: “ Weiterer Beitrag zur Klinik des Disgerminoma ovarii ” (Robert Meyer), Arch. f. Gynak. 159: 98-99, 1935. This is an answer to an article by Klaften (Arch. Gynak. 158: 544, 1934. Abst. in Am. J. Cancer 25: 892, 1935) in which he said that ovarian disgerminomas have an “ exquisite malignancy.” While it is true that certain disgerminomas, as well as certain granulosa-cell tumors, may be malignant, Kleine does not believe that they can be spoken of as a group possessing “ exquisite ” malignancy. BENJAMINR. SHORE

A Granulosa-cell Tumor, Bladder Carcinoma, and Uterine Myoma in a Fifty-Seven- Year-Old Woman, G. OPITZ. uber einen Fall von Granulosazelltumor, Blasen- karzinom und Myoma uteri bei einer 57 jahrigen Frau, Zentralbl. f. Gynak. 59: 2104-2108, 1935. The case is reported of a fifty-seven-year-old woman who died two days following the removal of the uterus and adnexa for a uterine myoma, and a partial excision of the bladder wall for a primary carcinoma. Histologic study of the ovaries showed a small granulosa-cell tumor on the left side. The article is illustrated with photographs and two photomicrographs. BENJAMINR. SHORE

Marked Uterine Hypertrophy in Association with an Ovarian Granulosa-cell Tumor, Z. V. SZATHMARY.Mit Granulosazelltumor zusammenhangende, ungewohnlich hochgradige Uterushypertrophie bei einer 63-jahrigen Kranken, Zentralbl. f. Gynak. 59: 2477-2482, 1935. The case is reported of a sixty-three-year-old woman with a granulosa-cell tumor of the left ovary and hypertrophy of the uterus. The latter measured 21 x 13 x 10 cm., and weighed 780 gm., which was about thirteen times its normal size. Myomas were not present. This is the first instance in which great uterine hypertrophy has been reported in association with an ovarian granulosa-cell tumor. A photograph and two photomicrographs illustrate the article. BENJAMINR. SHORE

A Special Type of Connective-tissue Tumor (Fibroma Thecocellulare Xanthomatodes Ovarii) of the Ovary, E. LOFFLERAND A. PRIESEL.Bindegewebige Gewachse des Eierstockes von besonderer Bauart (Fibroma thecocellulare xanthomatodes ovarii), Beitr. z. path. Anat. u. z. allg. Path. 90: 199-221, 1932. Theca-cell Tumors of the Ovary, E. LOFFLER AND A. PRIESEL. Thekazellengewachse des Eierstockes, Wien. med. Wchnschr. 84: 400-403, 1934. Six examples of a special type of fibroma of the ovary are described in the earlier of these two papers, and their structure illustrated by photographs of three of the gross specimens and by fourteen photomicrographs. Five of the six patients were past the menopause. In each instance the tumor involved one ovary only. The growths were usually recognizable on gross examination because of their yellow color. They varied from the size of a bean to the size of a fist. They were solid and showed no sign of degenerative change. In five of the cases the tumors were benign, but the sixth was apparently malignant, for it had bled into the cystic spaces contained in it and it had caused ascites. Histologically the tumors were made up of connective-tissue cells which were remarkable for their high lipoid content. Some areas were firm and fibrous, while in others the great amount of lipoid in the cells resulted in a soft xanthomatoid appearance. The authors believe that these tumors constitute a special type, and that they arise from the cell groups which form the theca interna of the graafian follicle. In their second paper the authors report 4 additional cases. One of these was in a girl of eighteen. C. D. HAAGENSEN

Theca Cell Tumors, SAMUELH. GEIST. Am. J. Obst. & Gynec. 30: 480-495, 1935. Geist adds 5 cases to the literature on the subject of solid tumors of the ovary developing from primitive cell types. Loffler and Priesel (see preceding abstract) have assembled a group of 10 cases of ovarian tumors which histologically are derived from the 624 ABSTRACTS theca cells of the ovarian parenchyma. These tumors are usually unilateral; about 85 per rent of them occur after the menopause, whereas the granulosa-cell tumors occur before the menopause in about half the cases. Clinically the tumor manifests itself by abnormal vaginal bleeding in addition to the presence of a pelvic mass which may reach the size of an adult’s head. The tumors resemble fibromas superficially and may show evidence of degenerative change, but the cut surface is distinctive. The color is usually yellowish white, owing to the presence of yellow cellular islands interspersed with hyaline connective-tissue bundles. Histologically the yellow areas show spindle or polygonal cells with elongated or irregular nuclei, staining deeply. Globules of fat and pigment are commonly found. The characteristic feature of the stroma is the presence of large hyaline plaques present in the midst of cellular islands with fibers extending out radially and either surrounding or appearing to enter the individual cells. Chemical studies made by the author show that they contain fat in the form of cholesterol ester and cholesterol. This contrasts with the existence of fat in granulosa-cell tumors as phos- pholipid. Theca-cell tumors were found on one analysis to contain amounts of estro- genic hormone somewhat greater than are found in placenta. The 5 new cases are presented in some detail, with photographs and photomicrographs of each. JOHNS. LOCKWOOD

Differential Diagnosis of Cystic Tumors of the Female Genital Tract by Histologic Study of Dried Smears, A. W. HOCHLOFF.Differentialdiagnostik von cystosen Tumoren des weiblichen Geschlechtsapparates am Eintrocknungsbild, Zentralbl. f. Gynak. 59: 321-323, 1935. This is a preliminary report concerning the characteristic appearance of ascitic fluid and fluid obtained from ovarian and parovarian cysts aspirated through the vagina. A drop of fluid is placed upon a slide, evaporated at 37 degrees, and studied macro- scopically and microscopically. Each type of ovarian and parovarian cystic tumor forms characteristic crystals in the ring of dried protein. Six photographs illustrate the article. BENJAMINR. SHORE

Epulis in an Ovarian Dermoid Cyst, Z. v. SZATHMARY.In ovarieller Dermoidcyste vorgefundene Epulis, Zentralbl. f. Gynak. 59: 2547-2550, 1935. The case is reported of a twenty-four-year-old woman in whom a typical epulis was found in a dermoid cyst of the left ovary. Besides this tumor there were teeth, hair, cartilage, and other characteristic structures of a dermoid cyst. This is the first case in which an epulis has been reported in an ovarian dermoid. Two photomicrographs illustrate the article. BENJAMINR. SHORE

Ovarian Cyst with Torsion of the Pedicle. A Case in a Woman Seventy-Seven Years of Age, C. R. ROBINS. South. Med. & Surg. 97: 549-551, 1935. A seventy-seven-year-old woman with a twisted, multilocular, papillary cystadenoma of the right ovary was operated upon and made an uneventful recovery. Several drawings illustrate the article. BENJAMINR. SHORE

Myofibroma of the Ovary with Heteroplastic Bone Formation, I. F. STEIN. Am. J. Obst. & Gynec. 30: 289-290, 1935. An illustrated case report without remarkable features. JOHNS. LOCKWOOD

Generalized Peritoneal Metastasis from Benign Ovarian Papillomas, F. POSATTI.Zur Frage der peri tonealen Generalisierung gutartiger Ovarialpapillome, Zentralbl. f. Gynkk. 59: 2864-2871, 1935. There are four groups of generalized metastases from serous papillary ovarian tumors: (1) generalized spread to the intraperitoneal organs leading rapidly to death; (2) metastatic tumors to the omentum and peritoneum, which disappear following the removal of the primary growth; (3) generalized metastases in which there is very slight or no impairment of health so that patients may live comfortably for a considerable length of THE GENITO-URINARY TRACT 625 time; (4) those cases which at the time of the first operation show a relatively benign type of tumor and which at subsequent operations may show the clinical and morphologic characteristics of malignancy. A case is reported to illustrate the third group of cases. A patient with generalized metastases of one year’s duration was in comparatively good health, without weight loss and without discomfort. Histologic study of a biopsy specimen showed the growth to be a benign serous papilloma. The patient was given roentgen-ray therapy, was aspirated several times, and lived seven years. Four photomicrographs illustrate the article. BENJAMINR. SHORE

Impacted Feces Simulating Ovarian Tumors, W. FISCHER.Eierstocksgeschwulste vortauschende Kotsteine, Zentralbl. f. Gynak. 59: 324-325, 1935. The author reports the case of a fifty-five-year-old woman with impacted feces in whom the palpable pelvic masses led to the clinical diagnosis of ovarian tumors. A correct diagnosis was made following roentgenographic study of the colon. BENJAMINR. SHORE

Cancer of the Female Urethra, E. S. AUER. Am. J. Obst. & Gynec. 30: 318-322, 1935. Auer reports the results of treatment in 22 cases of carcinoma of the female urethra. Five out of 13 patients treated more than five years ago have survived. It is definitely concluded that the treatment of choice in all cases must include radical excision of the lymph nodes both above and below Poupart’s ligament. The local lesion may be excised or treated with radium. The author considers the prognosis good except in cases which are obviously hopeless when first seen. JOHN s. LOCKWOOD

Cavernous Hemangiomas or Venectasia of the Urethra, 0. HAJEK. Reitrag zur Frage: Cavernoses Hamangiom oder Venektasien der Urethra? Zentralbl. f. Gynak. 59: 2099-2100, 1935. The author reports the case of a twenty-five-year-old woman from whom a pedunculated, vascular tumor, arising 1 cm. inside the external urethral orifice was surgically removed. Histologic study showed it to be composed of large venous sinuses filled with thrombosed blood. The question is raised whether this can be considered a new growth of the venules or simply a dilatation of these structures. No definite conclusion is reached. The article is illustrated with a photograph and a photomicrograph. BENJAMINR. SHORE

Case of Melanoblastoma of the Vulva, 2. RUFFEL. Ein Fall von Melanoblastom der Vulva, Zentralbl. f. Gynak. 59: 326-331, 1935. The author reports the case of a seventy-eight-year-old woman who was admitted to the hospital in extremis and died three days later. She had a primary melanosarcoma of the vulva with diffuse metastases to all the internal organs and skeleton. Five photomicrographs illustrate the article. BENJAMINR. SHORE

THE GENITO-URINARY TRACT

Kidney, Bladder, and Prostatic Carcinomas, G. VON ILLP~S.Erfahrungsergebnisse bei Nieren-, Blasen-und Prostatakrebs, Ztschr. f. urol. Chir. 41 : 123-132, 1935. In a series of 385 bladder tumors there were 218 papillomas and 167 carcinomas. In the carcinoma group were 120 men and 47 women. Resections were performed in 54 cases, with an operative mortality of 9.2 per cent. Excision and radium therapy were employed in 30 cases, electrocoagulation in 18, and external roentgen irradiation in 41, which were inoperable. Two patients survived four years and one five years after resection, while only one patient survived three years following radium and roentgen irradiation. 626 ABSTRACTS

Of 154 malignant kidney tumors, 96 were hypernephromas, 4 carcinomas, 1 angioma, and 12 papillary tumors of the kidney pelvis. Eighteen exploratory operations and 113 nephrectomies were done, with 7 deaths, giving an operative mortality of 5.3 per cent. Cures of from four to six years were obtained in 10 of 37 patients on whom nephrectomies were done. Of 325 patients with carcinoma of the prostate, 27 were operated on under the mistaken diagnosis of prostatic hypertrophy. Prostatectomy was done in 48 other cases, interstitial irradiation in 57, and roentgen irradiation in 162 cases. Five-year cures were obtained in 8, or 29.6 per cent of the 27 cases in which the diagnosis before prostatectomy was benign hypertrophy, and in 5, or 10 per cent, of the 48 cases in which prostatectomy was done for suspected malignancy. One patient remained well four years following interstitial irradiation, and two patients remained well five years following external roentgen irradiation. BENJAMINR. SHORE

A Case of Renal Teratoma, T. TAKUMAAND T. ISEIIGURO. Cann 30: 121-131, 1936. The patient was a seven-months-old girl. One month after her birth, a tumor, 10 x 10 x 12 cm. was noticed at the right costal arch. This enlarged gradually and finally spread to the abdominal cavity. Hydronephrosis was also present. Nephrectomy was done. Histologic examination of the tumor revealed nerve cells, bones, cartilage, smooth muscle, transverse striated muscle, hair, sweat glands and sebaceous glands. In a part of the tumor was cutaneous tissue becoming horny, indicating that the growth was a mature teratoma. The child is nearly two years old at present and well. The article is illustrated with photographs of the patient and tumor specimen, as well as roentgenograms and photomicrographs. K. SUGIURA

Papillomas of the Kidney Pelvis, K. STERNBACH.Nierenbeckenpapillome, Ztschr. f. urol. Chir. 41: 219-220, 1935. Two patients with papillary tumors of the kidney pelvis were treated by nephrectomy and ureterectomy. Unilateral renal hematuria was the presenting symptom in both cases. The diagnosis of a papillary tumor arising in the kidney pelvis was made in each instance by cystoscopy and ureteral catheterization. A follow-up report is not included. There are no illustrations. BENJAMINR. SHORE

Lymphogranulomatosis of the Ureters, K. SCHULER.Beitrag zur Frage der Lympho- granulomatose in den harnableitenden Organen, Ztschr. f. urol. Chir. 41 : 253-259, 1935. The author reports two cases of generalized lymphogranulomatosis in which partial ureteral obstruction was caused by nodules of tumor in the walls of the ureters. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE

Prognosis in Papilloma of the Bladder, C. A. R. NITCH. Lancet 2: 781-782, 1935. Every papilloma of the bladder is a potential malignant growth, and the danger of malignancy increases with the frequency of recurrence. In the author's series of 97 cases, 9 or approximately 11 per cent developed carcinoma. He believes that this figure would undoubtedly have been higher had not the patients been examined at regular intervals, often over many years, and recurrences kept in check. There is little doubt that the outlook as regards both recurrence and malignancy depends on frequent and regular cystoscopic examination, for there may be as much as twelve to eighteen months interval between noticeable hemorrhages, which are often the only symptom of the growth.

Atypical Carcinoma of the Urinary Bladder Simulating Myosarcoma. Report of Two Cases and Review of the Literature, S. M. RABSON. J. Urol. 34: 638-669, 1935. Two cases of carcinoma of the urethra and bladder are reported in which a tentative diagnosis of sarcoma was made upon histologic study of biopsy material. At autopsy a THE GENITO-URINARY TRACT 627

solid carcinoma was found in the first and a papillary transitional-cell carcinoma in the second case. The author has reviewed the literature and includes in abstract form 8 cases of alveolar sarcoma, 11 angiomas, 14 cases of epitheliosarcoma, 6 of lymphosarcoma, 21 of mixed-cell sarcoma, 18 of myosarcoma, 61 of round-cell sarcoma, 37 of spindle-cell sarcoma, 26 of teratoma, and 24 of unidentified sarcoma. Many of these tumors are believed to have been anaplastic carcinomas. Four photomicrographs illustrate the article. BENJAMINR. SHORE

Myomatous Tumors at the Neck of the Bladder, E. KORNITZER.Zur Kenntnis der myomatosen Geschwulste des Blasenausgangs, Ztschr. f. urol. Chir. 40: 367-374, 1935. Two patients with small submucous myomatous tumors at the neck of the bladder suffered from obstructive symptoms similar to prostatic hypertrophy. These tumors arose from the muscularis of the bladder wall or from the sphincters. Such tumors are easily cured by surgical removal, either by the transurethral or suprapubic route. BENJAMINR. SHORE

Total Urethro-Cystectomy in the Female-a New Technique, H. B. FREIBERG.J. Urol. 34: 615-637, 1935. Also in J. Med. 16: 626-628, 1936.' The author describes a new technic for total urethrocystectomy for carcinoma of the bladder in women. Lumbar implantation of both ureters precedes removal of the bladder. The technic of total cystectomy consists of freeing the urethra and lower portion of the bladder through the perineal route and removal of the bladder through a suprapubic incision. By this procedure it is possible not only to free the bladder from its supporting structures but to control the blood supply prior to its injury. Inasmuch as the urethral structures are continuous with those of the bladder, it seems important that these also be removed since they, too, are potentially cancer bearers. Since the entire operation is done extraperitoneally and without hemorrhage, the attendant operative shock is materially lowered, and the possibility of peritonitis as a complication is eliminated. The histories of two patients on whom this operation has been performed successfully are reported. The article is illustrated by drawings and photomicrographs. BENJAMINR. SHORE

Sarcoma of the Prostate in Infants, Case Report and Brief Review of the Literature, E. H. RAY. J. Urol. 34: 686-689, 1935. One hundred and two cases of sarcoma of the prostate have previously been reported, 7 of this number occurring in patients less than twelve months of age. The author reports the case of an eight-months-old boy who was admitted to the hospital because of urinary retention of twenty-four hours' duration. Attempts at catheterization were unsuccessful and a suprapubic cystostomy was done. Two short superficial incisions were also made through the edematous perineum. Histologic study of the neoplastic tissue which soon grew through these perineal wounds showed the 'growth to be a spindle-cell sarcoma. The patient died three weeks after admission to ' the hospital. Autopsy showed a primary prostatic sarcoma with metastases to both lungs. One photograph and two photomicrographs illustrate the article. BENJAMINR. SHORE

Lymphoma of the Prostate, C. WEGELIN. Ueber ein Lymphom der Prostata, Wien. klin. Wchnschr. 48: 1236-1237, 1935. The author reports the case of a sixty-eight-year-old man from whom a tumor situated in the right lobe of the prostate gland was removed by the perineal route. He died twelve days after operation. The growth was well-encapsulated and measured 5.5 x 4.5 x 3 cm. Histologic study showed it to be composed of large numbers of lymphoid follicles enclosed in myomatous tissue. The diagnosis of a lymphoma arising in a prostatic myoma was made. It is suggested that lymphosarcomas of the prostate may have their origin in some such benign tumors. BENJAMINR. SHORE 628 ABSTRACTS

Primary Carcinoma of the Urethra, Report of a Case Occurring in the Male, A. MCNALLY. J. Urol. 34: 384-390, 1935. The author reports the case of a sixty-two-year-old man with a primary carcinoma arising in the perineal portion of the urethra. Histologic study of a biopsy specimen removed through the perineum showed the growth to be a squamous-cell epithelioma. 'The patient refused operation, metastases developed in the inguinal lymph nodes and a fungating tumor in the urethrotomy opening, and death occurred five months later. One photomicrograph illustrates the article. BENJAMINR. SHORE

Treatment of Carcinoma of the Penis, K. OVERHOF. Die Behandlung des Penis- karzinomes, Rontgenpraxis 7: 468-472, 1935. Since 1926, 22 cases of carcinoma of the penis have been treated in the University Institute of Radiation Therapy in Frankfurt a. M. These cases were divided into four groups according to the therapy which they received: the 4 patients in Group I received primary surgical treatment and immediate postoperative prophylactic irradiation; the 4 patients in Group I1 were operated on primarily but were not irradiated until recurrences were observed; the 8 patients in Group 111 received roentgen-ray therapy without surgery; and the 6 patients in Group IV received roentgen-ray therapy followed in less than three months by radical surgery. The surgical procedure consisted of amputation of the organ and dissection of the inguinal lymph nodes when this was possible. The results of treatment in the various groups were as follows: one patient in Group I died after three years, while the others lived from three to five years; 3 patients in Group I1 died during the first year and only one was living during the second year; 5 of the 8 patients in Group I11 are still living, one two years, 2 three years, one four years, and one over six years; of the 6 patients in Group IV, 3 are living, 2 over six years. It is concluded from this study that roentgen irradiation should be used more generally in the treatment of penile carcinoma; if satisfactory results are not obtained, surgery can be resorted to later. BENJAMINR. SHORE

Sarcoma of the Penis, Report of a Case and Review of the Literature, T. NAKAZAWA. 13in Fall vom Penissarkom; zugleich Allgemeines uber dasselbe, Gann 29: 310-324, 1935. The patient was a sixty-five-year-old mine worker with congenital phimosis. He had twice had gonorrhea. Fifteen years earlier he had noticed a small solid tumor, 3 mm. in diameter, on the glans penis, which in the course of three years came to occupy the entire surface of the glans. Growth was temporarily arrested, but the tumor began to enlarge again two years prior to admission. Dysuria was marked. There were several grayish red, solid nodules on the glans, with swelling in both inguinal regions. Amputa- tion of the shaft was followed by radium irradiation, but the tumor continued to grow and a large ulcer developed. The patient died two months later of pneumonia, and autopsy revealed extensive pulmonary metastases. The tumor was histologically a spindle-cell sarcoma. Only four such cases had been previously reported in Japan. The article is illustrated with a photograph and two photomicrographs. K. SUCIURA

Histiocytic Sarcoma of the Penis and the Inguinal Region, L. M. PAUTRIERAND FR. WORINCER. Sarcome histiocytaire de la verge et de la region inguinale, Bull. SOC. franc;. dermat. et syph. 42: 826-832, 1935. A seventy-two-year-old man had an ulcerating, proliferating tumor of the penis and right groin which had been present for about four months. The tumor had been noticed first when it was a small collection of minute nodules; these coalesced and grew rapidly. No tumors were observed anywhere else on the body. A biopsy revealed a tumor made up of round, elongated, and irregularly shaped cells with abundant cytoplasm, multiple nucleoli, and many abnormal mitoses. In some areas the cytoplasm was finely granular, as in xanthoma cells. The stroma was scanty but rich in collagen fibrils. No myofibrils were demonstrated. By the term histiocytic sarcoma, the authors explain that they THE GENITO-URINARY TRACT 629 mean a tumor resembling Ewing’s reticulum sarcoma of .bone but not falling definitely into that category. A photograph of the patient and two photomicrographs are presented. THEODORE P. EBERHARD

Radiation Treatment of Tumors of the Testicle, G. G. SMITH,R. DRESSER AND E. R. MINTZ. J. Urol. 34: 462-469, 1935. This paper is based upon a study of 100 cases of testicular tumors collected from the Massachusetts General Hospital, the Palmer Memorial Hospital, the Collis P. Hunting- ton Hospital, and the State Cancer Hospital at Pondville, Mass. There were 49 embryonal carcinomas and sarcomas, 35 teratomas and mixed tumors, 8 carcinomas 4 miscellaneous growths, and 4 tumors in which the histologic structure was not known. The highest incidence was in the decade between twenty and thirty years, followed by the decade between thirty and forty. The teratomas tend to develop somewhat earlier than the embryonal carcinomas. In five cases the testes were incompletely descended at the time the tumor developed, or orchidopexy had been done. In one patient the tumor developed in an intra-abdominal testis. Metastases were present in the lumbar lymph nodes in 39 per cent and in the lungs in 23 per cent of the cases. Skeletal metastases were observed in 4 cases. Fifteen per cent of the patients were apparently well two or more years after orchidectomy; of these, 6 had been treated with irradiation. In only one patient of this group were metastases detected. So far as is known, all patients who showed metastases when irradiation was instituted have died of the disease or still show metastases. BENJAMINR. SHORE

Selective Irradiation in the Management of Teratoma Testis, R. S. FERGUSON. J. Urol. 34: 458-461, 1935. An increase in the target skin distance and filtration and a further division of the dose with the attainment of a higher total dose are desirable for the more radio-resistant types of testicular teratomas. For the more sensitive types, intensive irradiation with less filtration and larger daily dosage is preferable. If the histologic structure of a tumor is known, or the biological response to previous treatment is known, a fairly accurate prediction of radiosensitivity or resistance may be made. BENJAMINR. SHORE

Carcinoma of the Testicle, Postoperative Sequelae, Treatment and Comments, F. H. KUEGLE. Wisconsin M. J. 34: 920-921, 1935. The author reports the case of a twenty-six-year-old man upon whom a simple orchidectomy for a primary testicular carcinoma was performed in 1927. The spermatic cord was removed several months later but showed no evidence of malignancy. The patient was in comparative good health for about three years, after which time there appeared signs of metastatic tumor in the skeletal system and a recurrent mass in the pelvis. Several series of roentgen-ray treatments (amount not stated) were given, with marked relief of symptoms but without altering the general course of the disease. Death occurred six years and ten months following orchidectomy and approximately eight years after the onset of the disease. BENJAMINR. SHORE

Carcinoma of the Vas Deferens, Report of a Case, G. J. THOMPSONAND F. PILCHER,JR. J. Urol. 34: 714-717, 1935. A sixty-nine-year-old man with a primary carcinoma of the prostate gland and neoplastic involvement of the left vas deferens was operated upon by the transurethral route to relieve urinary obstruction and the vas was partially resected to prevent exacerbations of chronic epididymitis. Histologic study of the vas deferens showed an essentially normal mucosa with carcinomatous invasion of the muscular layer. This tumor was identical with that of the prostate gland. Two photomicrographs illustrate the article. BENJAMINR. SHORE 630 ABSTRACTS

THE NERVOUS SYSTEM

Tumors of the Brain in Infancy, S. W. GROSS. Am. J. Dis. Child. 48: 739-763, 1934. The author reviews the literature on brain tumors in infancy and reports 9 cases occurring in the first two years of life. Because of the elasticity of the cranial bones at THE NERVOUS SYSTEM 63 1 this period, allowing spontaneous decompression as the tumor enlarges, the manifestations differ from those of similar lesions in adults. The author’s series included 3 ependymomas, a pineoblastoma, an astroblastoma, an astrocytoma 2 medulloblastomas and an embryonic tumor of neuro-epithelial origin closely related to the medulloblastomas. Teratoma and sarcoma have been reported by others. Seven of the author’s series were in the midcerebellar region, one, an astroblastoma, was in the left cerebral hemisphere, and one was in the pineal region. All of the ependymomas were in the fourth ventricle and were solid tumors, histologically resembling ependymomas in other age periods. The medulloblastomas also presented the typical gross and microscopic features of this tumor in later childhood. Eight of the patients were males, the sex incidence corresponding to that reported by Wollstein and Bartlett, who found 7 of 9 cases in children under the age of three in boys (Am. J. Dis. Child. 25: 257, 1923). Hydrocephalus was present in all the cases, and in 7 was the most prominent feature. Vomiting occurred in 7 cases. Choked disks were present in 5 instances; in 3 others the retinal veins were engorged, and in one the fundi were described as normal. In only 3 cases was a brain tumor suspected. In 7 patients operation was done. The other 2 children died shortly after admission. Only one of the patients operated upon survived. This was a fourteen-months-old infant with a midline astrocytoma. The mural nodule and part of the cyst wall were removed. The child was in good condition a month later but was subsequently lost sight of. Diagnosis of brain tumors in infancy is made difficult by the chaotic state of the conventional neurologic reflexes at this age and by the difficulties of carrying out tests which require intelligent cooperation on the part of the patient. Hydrocephalus due to other causes, especially obstruction of the aqueduct, subdural hematoma, and abscess are to be differentiated. In the presence of aqueduct obstruction the head is usually enlarged at birth or shortly thereafter. In all of the author’s cases the head was described as normal at birth. Subdural hematomas occur usually in the first year of life and are usually associated with nutritional disturbances or infectious disease. Brain abscesses are rare in infancy. Their presence should be suggested by the history of a septic focus elsewhere. The case reports, which are given in some detail, are illustrated by photographs and photomicrographs of the tumors, and a ventriculogram from one case is reproduced. A bibliography is included.

Brain Tumors in Childhood, Review of Thirty-eight Cases, C. W. RANDAND R. J. VAN. WAGENEN.J. Pediat. 6: 322-339, 1935. Thirty-eight cases of verified and suspected brain tumors in children under thirteen years of age were seen in 11,340 patients admitted to the Medical Service of the Child- ren’s Hospital in Los Angeles from Jan. 1, 1924, to May 1, 1934. There were 18 verified gliomas, 15 probable but unverified gliomas, 3 verified tuberculomas, 1 verified cyst of Rathke’s pouch, and 1 verified rholesteatoma. The symptoms in their order of frequency were as follows: persistent periodic vomiting, headache, disturbances in gait, oculomotor palsies of various types, enlargement of the head, failing vision, nausea, convulsions, morning vomiting, and nystagmus. Without exception, failure to use of the ophthalmoscope was most evident in delayed or faulty diagnosis. Only one child from the entire group of 38 patients is living at the time of this report. The article is not illustrated. BENJAMINR. SHORE

Brain Tumors in Children, 0. MARBURG.Die Hirntumoren im Kindesalter, Wien. klin. Wchnschr. 48: 257-261, 294-297, 1933. This is a general review of the symptomatology, diagnosis, and treatment of brain tumors in children. It is unillustrated and, though it contains numerous references to other authorities, no bibliography is included. BENJAMINR. SHORE 632 ABSTRACTS

Multiple Primary Tumors of the Brain. Review of the Literature and Report of Twenty-one Cases. CYRILB. COURVILLE,Am. J. Cancer 26: 703-731, 1936. * Courville reports a series of 21 autopsied cases of multiple gliomas and presents in tabular form 113 other cases collected from the literature. On the basis of his own observations he estimates the incidence of multiple gliomas in a series of autopsies to be about 0.06 per cent, among intracranial tumors in general 4.3 per cent, and among gliomas above 8 per cent. The tumors were found chiefly in the cerebral hemispheres. They varied in size, degree of invasiveness, and in the nature and degree of regressive change. The majority were multiform glioblastomas. The author suggests several explanations for the occurrence of these multiple tumors. The most logical, in his opinion, is the development of multiple independent foci. ‘The paper is illustrated by drawings showing the location of the tumors in the 21 cases reported. A long bibliography is appended, and references to the reports in the literature are included in the table of collected cases.

Cerebrospinal Fluid in Brain Tumor Cases, H. DEMME. Liquorbefunde bei Hirn- geschwulsten, Deutsch. Ztschr. f. Nervenheilk. 136: 21 1-225, 1935. Obstruction to the flow of cerebrospinal fluid in the intracranial cavity and in the spinal canal produces identical changes. Above the obstructing lesion there is normal or nearly normal fluid, while below changes in the protein and cell content are frequently seen. This depends to a large degree upon the degree of obstruction. Infratentorial tumors of the posterior cranial fossa, and especially those of the cerebello-pontine angle, are apt to give rise to the most marked changes. The tests which are the most valuable are the quantitative estimation of protein, the Wassermann reaction, and the cell count. For practical purposes, estimation of the sugar content of the cerebrospinal fluid has little value. BENJAMINR. SHORE

Cerebrospinal Fluid Obtained by Lumbar and by Ventricular Puncture in Tumors of the Brain, C. C. HARE. Bull. Neurol. Inst. New York 4: 64-90, 1935. A study was made of the composition of the cerebrospinal fluid in 218 verified tumors of the brain. In 186 cases the fluid was obtained by lumbar and in 79 by ventricular puncture. Increase of protein and of globulin in the fluid obtained by a lumbar puncture occurred in 61 per cent of meningiomas, in 64.8 per cent of multiform glioblastomas, and in 100 per cent of acoustic neuromas and other tumors in the lateral recess of the posterior cranial fossa; in 35.4 per cent of supratentorial and in no subtentorial astrocytomas, in 60 per cent of supratentorial and in 20 per cent of subtentorial medulloblastomas. In intracranial tumors of other pathologic types increase of protein and globulin occurred in some cases but not in others. Increases were not found in the oligodendrogliomas, dermoid cysts, or papillomas of the choroid plexus. Changes in the protein and globulin of fluid removed by ventricular puncture were more infrequent. In supratentorial growths in one cerebral hemisphere the fluid removed from the lateral ventricle of that side will often contain more protein and globulin than that from the other ventricle. Among the infiltrating tumors, increase of protein and globulin in the lumbar fluid is more frequent in the glioblastomas and astrocytomas when the tumor is entirely subcortical. The largest increase of protein and globulin in the lumbar fluid was found in the multiform glioblastomas and in acoustic nerve tumors; and in the ventricular fluid in the multiform glioblastomas. The increase of protein in the lumbar fluid varied between 50 and 490 milligrams, and of globulin between one and four plus. The study of the spinal fluid was of little value in the differential diagnosis of tumors from other diseases of the brain. BENJAMINR. SHORE

Changes in the Cerebrospinal Fluid in Cases of Meningeal Tumors, 0. GLETT~NBERG. Zur Liquordiagnostik der Hirntumoren, insbes. der Meningiome bzw. der menin- gealen Tumoren, Deutsch. Ztschr. f. Nervenh. 136: 226-235, 1935. A decided increase in the protein content of the cerebrospinal fluid is usually present in cases of meningiomas and in cases in which the meninges are involved by metastatic THE NERVOUS SYSTEM 63 3

malignant tumors. Other intracranial tumors, especially gliomas, which cause meningeal irritation or which are associated with marked degenerative changes, may also cause an increase in the spinal fluid protein. BENJAMINR. SHORE

Vision and Its Disturbances in Relation to Cerebral Lesions, WILFRED HARRIS. Lancet 1: 1139-1144, 1935. This paper covers a variety of cerebral lesions. The following observations are made concerning tumors. Cerebellar tumors may cause pressure on the dorsum of the optic chiasm, producing bitemporal hemianopia followed by complete blindness and optic atrophy. Tumors of the sphenoid may compress the optic nerve, causing ultimate blindness. The pressure exerted by adamantinomas of Rathke’s pouch and other tumors of the pituitary may result in a wide variety of visual field defects. Sometimes the growth escapes through the diaphragma sellae and presses upon or even destroys one optic tract, causing homonymous hemianopia, or it may press forward in front of the chiasma and produce partial or complete blindness of one eye. Partial hemianopia is sometimes found in association with temporal tumors. A lesion close to the parietal cortex may produce either complete hemianopia or a quad- rantic lesion of the lower fields. Hallucinations occur in the blind fields of patients suffering from hemianopia due to various lesions from the optic tract to the occipital cortex. They have been described in occipital and, more particularly, in temporal tumors. A bibliography is appended.

Rhinorrhea and Neoplasms of the Central Nervous System, R. E. BRITT. J. Nerv. & Ment. Dis. 81 : 654-661, 1935. Brain tumors apparently are the most frequent cause of the spontaneous escape of cerebrospinal fluid from the nose. Two cases are reported, one of a cerebellar tumor and the other of an undiagnosed deep-seated cerebral lesion, in which the rhinorrhea was probably due to a pressure defect in the lamina cribrosa. This was verified in the case of the cerebral tumor, which came to autopsy. The article is illustrated with three photographs. BENJAMINR. SHORE

Bladder Dysfunction in Cases of Brain Tumor, Cystometric Study, J. W. WATTSAND C. A. W. UHLE. J. Urol. 34: 10-30, 1935. The degree of bladder dysfunction in 11 patients with intracranial neoplasms was determined by injecting increasing amounts of fluid into the bladder through a catheter, the pressure being recorded after each 50 C.C. of fluid was introduced. A record was made of the capacity at which the patient had the first desire to void, the first sensation of discomfort, and the first evidence of pain, and these observations were compared with the normal. The study demonstrated that so-called neurogenic bladders of the hypotonic and hypertonic types may be due to intracranial neoplasms. The changes in sensation and tonus, and the urinary disturbances such as difficult micturition and retention, urgency and incontinence, are attributed to a disturbance of the bladder representation in certain parts of the brain. Patients with hypotonic reactions had difficult urination followed by retention requiring catheterization. The first desire to void, the feeling of distention and pain usually occurred later in these patients than in normal subjects. In patients with hypertonic reactions there was usually a history of urgency and involuntary urination; the desire to void often occurs with very little fluid in the bladder. BENJAMINR. SHORE

Bradycardia as a Symptom of Brain Tumors and Abscess, J. RASDOLSKY. Die Brady- kardie bei Geschwulsten und Abscessen des Gehirns, Deutsche Ztschr. f. Nervenh. 137: 126-131, 1935. In a series of 234 proved cases of brain tumor a spontaneous, more or less constant bradycardia was present in but 7, or about 3 per cent, while in a series of 45 cases of 634 ABSTRACTS brain abscess this symptom was present in 75 per cent. When bradycardia does occur in association with brain tumors, it is believed to be due not to high intracranial pressure alone but to a sudden increase of this pressure. BENJAMIN R. SHORE

Recognition of Some Forms of Intracranial Lesions, C. W. SCHWARTZ.Am. J. M. Sc. 190: 220-225, 1935. tinfortunately both the patient and his physician are reluctant to admit the possibility of intracranial trouble before the condition has progressed to such an extent that there remains but little doubt of the diagnosis. Of the proved cases of intracranial disease, about 70 per cent will give evidence in roentgenograms to indicate the presence of disease, while in about 30 per cent it will be possible to arrive at a fairly accurate localization of the process. The general roentgenologic signs of intracranial disease are those of pressure, such as atrophy of the sella turcica, increase in number and depth of the convolutional impressions together with a lack of clarity of their outlines, separation of the sutures, and general halisteresis of the skull bones. The localizing signs are five in number; calcification, bone proliferation, bone absorption, localized area of hyper- vascularity, and displacement of the pineal shadow. In the presence of any one of the localizing signs, a diagnosis may be possible, and with more than one present, the lesion can usually be recognized and often identified. Eleven roentgenograms illustrate the article. BENJAMIN R. SHORE

Responsibility of the Roentgenologist in the Detection of Intracranial Tumors, K. KOKNULUM.Am. J. Koentgenol. 33: 752-763, 1935. In a series of 446 verified intracranial tumors, roentgenologic examination showed deformation of the sella turcica in 64.6 per cent of the cases, convolutional atrophy in 8.8 per cent, calcification of the tumor in 6.5 per cent, widening of the sutures in 4.6 per cent, local bone erosion in 2.9 per cent, local hyperostosis in 1.8 per cent, lateral shift of the pineal body in 1.8 per cent, and widening of the diploic channels in 0.2 per cent of the cases. Since patients with brain tumor are usually first seen by the general practitioner and often first examined by the local roentgenologist, all general roentgenologists must share the responsibility for the early detection of such lesions. The article is illustrated with roentgenograms. BENJAMIN R. SHORE

Reliability of Brain Tumor Localization by Roentgen Methods, F. J. HODCESAND V. C. JOHNSON. Am. J. Roentgenol. 33: 744-751, 1935. In a series of 190 proved cases of intracranial neoplasms, 58.4 per cent were identified as encephalic tumors, 23.7 per cent as tumors of covering cells, 12.1 per cent as hypophyseal tumors, 3.2 per cent as disembryomas, and 2.6 per cent as vascular tumors. By clinical examination alone, correct diagnosis and localization of tumors were obtained in 51.6 per cent of the cases; routine skull roentgenograms added 12.6 per cent correct diagnoses where neurologic methods had failed; encephalography unassisted added 4.8 per cent, and ventriculography, reserved for cases resisting simpler forms of examination, made possible the correct diagnosis of 25.8 per cent of the cases. Only 5.2 per cent of this group of 190 proved tumors eluded correct preoperative recognition and localization. BENJAMIN R. SHORE

Diagnosis of Intracranial Tumors by Roentgenologic Changes in Form of the Sphenoid Sinus, R. MITTEKMAIER. Inwieweit konnen Formveranderungen der Keilbeinhohlen bei der Rantgendiagnostik endokranieller Geschwiilste verwertet werden? Ront- genpraxis 7: 513-518, 1935. The author describes the characteristic changes in the sphenoid bone caused by intracranial neoplasms, more especially those of the pituitary gland. Flattening of the sinus and variations from the normal parallel portion of the upper and lower plates are the chief changes observed with these tumors. Several roentgenograms illustrate the article. BENJAMIN R. SHORE THE NERVOUS SYSTEM 63 5

Roentgenologic Diagnosis of Tumors in the Sellar Region, B. H. NICHOLS. Am. J. Roentgenol. 33: 733-735, 1935. The important changes in encephalograms in cases of suprasellar tumors are: (1) complete or partial obliteration of the cisterna chiasmatis by the tumor; (2) elevation of the floor of the third ventricle or encroachment on its anterior portion; (3) separation of the anterior horns of the lateral ventricle; (4) visualization of the tumor mass by the surrounding air in the basilar cisterna and third ventricle. In a series of 24 intracranial tumors situated near the sella turcica in which the diagnosis was confirmed by operation, there were 11 pituitary adenomas, 1 medullary blastoma, 6 craniopharyngiomas, 1 glioma, 1 papillary carcinoma, 3 suprasellar cysts of Rathke’s pouch, and 1 meningioma. The article is not illustrated. BENJAMINR. SHORE

Ventriculographic Differential Diagnosis of Brain Tumors, H. PEIPER. ober die ventrikulographische Voraussage des Charakters von Hirngeschwulsten, Fortschr. a. d. Geb. d. Rontgenstrahlen 51: 113-118, 1935. The localization of intracranial tumors may be facilitated by the use of ventricu- lograms, but the differential diagnosis between various types of tumors cannot be made by this method; benign and malignant lesions may appear the same. It is pointed out that in some cases the diagnosis of brain tumors may be made with almost certainty by clinical examination even in the presence of a negative ventriculogram. The article is illustrated with roentgenograms. BENJAMINR. SHORE

Advances in the Surgical Treatment of Neurologic Conditions, H. KBBCKE. Fort- schritte der Neurochirurgie und ihre Bedeutung fur den Praktiker, Fortschr. d. Therap. 11: 1-11, 89-95, 142-149, 208-214, 1935. This is a general article concerning the diagnosis and treatment of various neoplastic and infectious lesions of the brain, intracranial hematomas, hydrocephalus, epilepsy, and lesions of the spinal cord and peripheral nerves. It is illustrated by drawings and roentgenograms. BENJAMINR. SHORE

Neurological Surgery, L. DAVIS. Wisconsin M. J. 34: 309-318, 1935. This is a general review of the diagnosis and surgical treatment of brain and peripheral nerve tumors and various lesions of the sympathetic nervous system. BENJAMINR. SHORE

Acute Visceral Disturbances Following Brain Operations, B. SCHLESINGER. Akute viscerale Storungen nach Hirntumoroperationen, Deutsche. Ztschr. f. Nervenh. 138: 75-82, 1935. Various abnormalities of visceral function following intracranial operations are probably dependent upon disturbances in the region of the brain stem. Pulmonary edema and ulcerations in the esophagus, stomach, and duodenum are probably dependent upon interference of innervation through the vagus nerves. The histories of two patients, one with pulmonary edema following the removal of a large meningioma and the other with a fatal gastric hemorrhage following partial removal of a basofrontal meningioma, are reported. The article is illustrated with two roentgenograms. BENJAMINR. SHORE

Roentgen Ray Treatment of Tumors of the Brain and Skull, C. G. DYKE. Bull. New York Acad. Med. 11: 392-402, 1935. Dyke believes that all intracranial tumors, with the exception of those of the pituitary gland, should be removed surgically if possible. There can be no doubt, however, that roentgen therapy is an aid in the treatment of intracranial tumors. This is especially true of pituitary adenomas, medullary blastomas, some astrocytomas, fibroblastic meningiomas, hemangiomas of bone, hemangioblastomas, angiomas of the brain, and multiple xanthomas. Multiform glioblastomas will occasionally respond to roentgen therapy. The neoplasms which tend to react unfavorably to irradiation are 636 ABSTRACTS acoustic neuromas, bucconeural pouch tumors, and many of the gliomas, such as oligodendrogliomas, astroblastomas, and ependymomas: also dermoid cysts, epidermoid cysts, and meningiomas, with the exception of the fibroblastic type. Roentgen therapy of intracranial tumors should be done, with few exceptions, only after the diagnosis has heen made by histologic examination of the tissue. Furthermore, it is advisable to treat these tumors only after a cranial decompression has been provided. The article is not illustrated. BENJAMINR. SHORE

Mental Symptoms in Cases of Tumor of the Frontal Lobe, I. STRAUSSAND M. KESCHNER. Arch. Neurol. & Psychiat. 33: 986-1007, 1935. Eighty-five frontal lobe tumors, 62 verified at autopsy and 23 by operation, were studied to ascertain: (1) the frequency and nature of mental symptoms in cases of tumors involving the frontal lobe; (2) their diagnostic value as localizin4 symptoms; (3) whether there were any definite determining factors in their production. The series included 53 gliomas, 24 meningiomas, 3 sarcomas, 2 non-aneurysmal vascular tumors, 1 metastatic carcinoma, 1 tuberculoma, and 1 mesodermal tumor of unknown origin. The average duration of symptoms for the entire group was eighteen months. Abnormal mental reactions occurred in 77, or 90 per cent of the cases, at some time during the course of the disease. These mental symptoms were the earliest manifestations of tumor in 43 per cent; changes in personality were the first evidence in over 30 per cent of the cases. Symptoms referable to disturbances of the sensorium, leading to faulty perception and attention, poor concentration, and lack of cooperation, were the most frequent mental symptoms and were observed in 61, or 71 per cent, of the cases. Next in order of frequency were changes in personality and disturbances in affect, intellect, memory, and orientation. Euphoria was present in 30 per cent, facetiousness in 22 per cent, and both in 13 per cent of the cases. The actual part of the frontal lobe involved by the tumors, that is whether cortical, subcortical, premotor, prefrontal, or subfrontal, could not be regarded as a determining factor in the frequency of mental symptoms or in their nature. Such determining factors in the order of their importance were as follows: (1) the extent of involvement of the brain tissue; (2) the rapidity of growth of the tumor; (3) the increased intracranial pressure; (4) the patient's previous mental make-up; and (5) possibly the convulsive state. In cases of rapidly growing, infiltrating tumors and of diffuse tumors, mental deterioration and changes in personality appeared much earlier than in cases of slowly growing tumors; in the latter, changes in personality might for a long time be the only mental symptom. Increased intracranial pressure was an important determining factor in the production of disturbances of the sensorium and of spontaneity of thought, action, and speech. There was no noteworthy difference in the frequency of occurrence of, and in the nature of, the mental symptoms caused by tumors or the right and left hemispheres. By themselves, mental symptoms are of little value in the diagnosis of frontal lobe tumors; mental pictures indistinguishable from those found in patients with frontal lobe tumors occur also in aged and arteriosclerotic patients and in patients with other organic diseases of the brain, regardless of their location. BENJAMINR. SHORE

Pathology of Cerebral Angiomas, Study of Nine Cases, A. WOLFAND S. BROCK. Bull. Neurological Inst. New York 4: 144-176, 1935. The histories of 9 patients with vascular malformations of the brain are reported in detail. Two had arteriovenous angiomas, 5 venous angiomas, and 2 capillary angiomas. 'The article is illustrated with photographs and photomicrographs. BENJAMINR. SHOKE

New Syndrome for the Diagnosis of Corpus Callosum Tumors, J. MICHELSON. Ein neues Syndrom zur Diagnostik von Balkentumoren, Deutsche Ztschr. f. Nervenh. 137: 152-176, 1935. The following symptoms were present in 7 cases of tumors involving the corpus callosum and are believed to form an important syndrome for the diagnosis of these lesions: THE NERVOUS SYSTEM 637

(1) deep-seated psychic disturbances which are not easily classified under the ordinary psychiatric groups; (2) fever in the absence of demonstrable infection; (3) xantho- chromia and an increased cell count in the cerebrospinal fluid. The histories of the seven patients forming the basis of this study are included. There are no illustrations. BENJAMINR. SHORE

Intramedullary Tumors of the Brain Stem, C. C. HAREAND A. WOLF. Arch. Neurol. & Psychiat. 32: 1230-1252, 1934. The clinical signs and autopsy findings in 7 cases of glioma of the brain stem are reported. In 3 instances the neoplasm was an astrocytoma fibrillare, in 3 a glioblastoma multiforme, and in 1 a polar spongioblastoma. Briefly the cases were as follows: Case 1: Eight-year-old girl. Symptoms of five years’ duration. Spastic quadri- plegia, sensory changes, and muscular incoordination. Impaired function of the fifth, seventh, eighth, ninth, and tenth cranial nerves. Polar spongioblastoma of the medulla, pons, and upper cervical cord. Case 2: Six-year-old girl. Ataxia of all of the extremities. Left hemiparesis. Impaired function of the fifth, seventh, and ninth cranial nerves of two months’ duration. Glioblastoma multiforme of the pons and medulla. Case 3: Six-year-old girl. Symptoms of six months’ duration. Left spastic hemi- plegia, nystagmus, left facial paresis, and difficulties in speech. Astrocytoma fibrillare of the medulla, pons, and midbrain, extending into the right thalamic region. Case 4: Six-year-old boy. Symptoms of four months’ duration. Ataxia of all of the extremities, signs of bilateral involvement of the pyramidal tract, right hemi- hyperesthesia, early papilledema, and impaired function of the fifth, sixth, eighth, ninth, tenth, eleventh, and twelfth cranial nerves. Glioblastoma multiforme of the medulla. Case 6: Nine-year-old boy. Symptoms of three months’ duration. Bilateral papilledema and contracted visual fields. Slight cerebellar signs. Astrocytoma fibrillare beneath the floor of the aqueduct of Sylvius, with obstructive hydrocephalus. Case 6: Sixteen-year-old girl. Symptoms of two years’ duration. Ataxia of all of the extremities and signs of bilateral involvement of the pyramidal tract. Bilateral papilledema and nystagmus. Hydrocephalus. Astrocytoma fibrillare about the aqueduct of Sylvius. Case 7: Eight-year-old boy. Symptoms of two weeks’ duration. Ataxia and weakness of right upper and lower extremities. Subjective sensory diminution on the left side of the body and right side of the face. Papilledema of 5 diopters. Involvement of the fifth, sixth, seventh, eighth, and twelfth cranial nerves. Glioblastoma multiforme of the pons, with metastases to the meninges. No definite syndrome characteristic of tumors of the brain stem can be evolved, but the manner of onset of the illness is of importance for diagnosis. In 4 of the reported cases the first complaint was of localizing symptoms, chiefly signs of involvement of the cranial nerves or disturbances of cerebellar function. In one patient the initial symptoms were those of an obstructive hydrocephalus, and in 2 others the illness began with localizing symptoms and evidence of increased intracranial pressure. In one case the illness began following tonsillectomy, and in another a similar operation was performed during the course of the illness. The manner of onset in most of these cases is thus quite different from that observed in patients with a neoplasm situated elsewhere in the brain. The extent of the neoplasm at autopsy was usually much greater than was to be expected from a study of the clinical signs and course of the disease. If the tumor is obviously intramedullary, operation is contraindicated. Six of the patients in the authors’ series were operated on and the longest survival was fourteen weeks. If there is doubt as to whether the tumor is inside or outside the brain stem, the posterior cranial fossa should be explored.

Spongioblastoma Polare of the Pons, C. PILCHER.Arch. Neurol. & Psychiat. 32: 1210-1229, 1934. The term spongioblastoma polare is used to designate that group of slowly growing gliomas which are composed predominantly of unipolar and bipolar spongioblasts. 63 8 ABSTRACTS

Such tumors are essentially transitional in character between the malignant primitive spongioblastoma multiforme and the benign mature astrocytoma. According to their cellular constitution the author classifies them as primitive, pure, and mature. He reports 11 cases arising in the pons, of which 3 were of the middle or pure type and 4 each of the primitive and mature types. The clinical manifestations are the same regardless of the type of tumor and are, with few exceptions, explained by the anatomopathological changes. Of special importance is the tendency of the neoplastic cells to spread along the natural planes between fiber groups, compressing them but not at first interfering with their function. Involvement of the cranial nerves and of the pyramidal tract occurred in every case. ‘The tumors are not amenable to surgery and are invariably fatal. The most valuable diagnostic criterion has been said to be the initial occurrence of slowly developing cranial nerve palsies and the absence or late appearance of intracranial hypertension, but this did not hold in all of the author’s series. Photographs and photomicrographs illustrate the case reports. A bibliography is included.

Epidermoid Cyst Compressing the Vermis of the Cerebellum, L. M. DAVIDOPFAND H. T. VON DEESTEN. J.A.M.A. 105: 873-874, 1935. The authors report the case of a forty-two-year-old man from whom an epidermoid cyst which compressed the vermis of the cerebellum was surgically removed. The cyst wall was thin and of a dark, opaque appearance. Histologic study showed the lining to be composed of two or three layers of epithelial cells, the basal layer being made up of large-bodied cuboidal cells. The patient made an uneventful recovery after his operation and was symptom-free two months later. There are no illustrations. BENJAMINR. SHORE Unilateral Exophthalmos Produced by a Meningioma of the Middle Cranial Fossa, Report of a Case, M. COHENAND J. E. SCARFF.Arch. Ophth. 13: 771-778, 1935. Slowly progressing unilateral exophthalmos associated with ophthalmoplegia, primary optic atrophy, and hyperplastic thickening of the posterior orbital plate on the side of the exophthalmos, constitutes a definite clinical and pathologic syndrome due to a rneningioma arising from the middle cranial fossa. The authors report the case of a seventeen-year-old boy with this syndrome in whom slight improvement of the exophthalmos was obtained by partial surgical removal of a meningioma arising from the left sphenoidal plate and involving the sphenoid foramen. The article is illustrated with photographs, photomicrographs, a roentgenogram, and a drawing. BENJAMINR. SHORE

Calcified Intradural Cholesteatoma of Unusual Size in B Patient Showing Manic- Depressive Symptoms, G. HORRAX,M. YORSHISAND G. R. LAVINE. Arch. Neurol. & Psychiat. 33: 1058-1074, 1935. A woman of forty-three had a large intradural cholesteatoma over the left cerebral hemisphere removed surgically. The tumor measured 15 x 11 x 8 cm., and weighed 400 gm. The surface of the growth was completely calcified, the shell averaging about a millimeter in thickness. Histologic study showed the lesion to be a typical cholesteatoma. The article is illustrated with photographs, roentgenograms, a drawing, and photomicrographs. BENJAMINR. SHORE

Parosmia in Tumorous Involvement of Olfactory Bulbs and Nerves, H. A. PASKIND. Arch. Neurol. & Psychiat. 33: 835-838, 1935. A forty-five-year-old woman experienced severe headaches, dizziness, and disturbances of loconiotion four years after the radical amputation of the left breast for carcinoma. An unusual symptom was a continuous sense of an unpleasant odor which could not be exactly described as any one smell. The odor did not come in momentary attacks or paroxysms but had lasted continuously for two weeks. At no time was there an alteration of consciousness such as is seen in patients with uncinate gyrus fits. Death THE NERVOUS SYSTEM 639 occurred several weeks after the removal of a metastatic carcinoma of the left cerebellar lobe. Autopsy showed metastatic carcinoma of the lungs, pleura, peribronchial nodes, various parts of the brain and spinal cord, kidneys, uterus, and ovaries. Attached to each olfactory bulb was a carcinomatous nodule about the size of a split pea. It seems reasonable to believe that this involvement of the olfactory bulbs and nerves was responsible for the unusual type of parosmia with which the patient was afflicted. The article is illustrated with a photograph and a photomicrograph. BENJAMINR. SHORE

Some Clinical Aspects of Pituitary Basophilism, R. C. MOEHLIG. J. Michigan State M. SOC.34: 263-267, 1935. Hyperplastic conditions of the pituitary gland as well as basophil adenomas may produce the clinical syndrome usually attributed to pituitary basophilism. The osteoporosis seen in these cases is probably due to the pituitary activation of the para- thyroid glands. It is believed that constitutional inheritance rather than the difference in glandular pathology is responsible for variations in the clinical picture. BENJAMINR. SHORE

Hormonal Changes in Cushing’s Disease, A. JORES. Uber Hormonuntersuchungen bei Morbus Cushing, Klin. Wchnschr. 14: 1348-1351, 1935. A thirty-five-year-old woman developed symptoms of Cushing’s disease after three pregnancies. She complained of hypertension, obesity, hypercholesteremia, and disturbances of menstruation. Hypertrichosis and osteoporosis were lacking. Hormonal studies showed a negative Aschheim-Zondek reaction, an increase of the melanophore hormone in the blood, and an increase of a hormone identical with that found in the adrenals of infantile white mice. BENJAMINR. SHORE

Cushing’s Disease, W. SCHON. Ein Beitrag zur Klinik des Morbus Cushing, Deutsche Ztschr. f. Nervenh. 137: 177-186, 1935. The history of a twenty-five-year-old patient in whom obesity, mental retardation, and diabetes, were the presenting symptoms is given. Roentgenograms of the skull showed a flattened and widened sella turcica with atrophy of the anterior clinoid processes. The clinical diagnosis of hypophyseal tumor was made, but had not been verified. The article is illustrated by photographs of the patient. BENJAMINR. SHORE

Return of Symptoms After Successful Removal of a Pituitary Tumor. Complete Restoration of Central and Perimetric Vision by Medical Treatment, J. V. CLOTHIER. Arch. Ophth. 13: 819-822, 1935. A woman fifty-three years of age experienced complete relief of symptoms following a subtotal removal of a chromophobe adenoma of the pituitary gland seven years previously, but failing vision in the right eye brought her again for treatment. Ophthalmo- scopic examination showed a complete temporal hemianopia in the right eye and a large defect in the superior temporal quadrant of the left eye. Roentgen study of the skull revealed pronounced enlargement of the sella turcica. A diagnosis of pituitary tumor, probably adenoma, was made. The patient was advised of the possible need for another operation but was first treated with thyroid extract and iodine preparations. Eighteen months later she was in good health, entirely free from headaches and able to attend to her household duties. Vision was normal in each eye, with correcting glasses. The prognosis in this case is altogether uncertain. It can be stated, however, that medicinal treatment has, for the time being at least, given as satisfactory a result as could have been expected from the most successful operation. If recurrences should take place, medicinal therapy will again be tried, reinforced if necessary, with irradiation. BENJAMINR. SHORE Two Cases To Illustrate the Regulation of Blood Pressure by the Hypophysis, E. KYLIN. Uber zwei Falle, die geeignet sind, die Bedeutung der Hypophyse fur die Blut- druckregulation zu erhellen, Deutsches Arch. f. klin. Med. 178: 217-229, 1935. Two patients, one a fifty-two-year-old woman with a basophilic hyperpituitary syndrome and the other a forty-seven-year-old woman with a basophilic hypopituitary 640 ABSTRACTS syndrome are described. In the first instance the blood pressure was increased, while in the second it was distinctly lowered. Two photographs illustrate the article. BENJAMINR. SHORE

Dwarfism and Early Hypophyseal Cachexia in a Case of Rathke’s Pouch Tumor, G. HABAN. Kleinwuchs mit beginnender hypophysarer Kachexie bei Hypophysen- gangsgeschwulst, Endokrinologie 15: 158-167, 1935. A thirty-eight-year-old man died five hours after extirpation of a cystic mass situated in the hypophyseal region. Autopsy showed the tumor to be of Rathke’s pouch type, and to have grown so as almost completely to destroy the hypophysis. All of the internal organs, especially those of internal secretion, were distinctly smaller than normal. Study of the long bones showed non-fusion at the epiphyses and maintenance of the epiphyseal lines. The dwarfism and atrophy of the internal organs, especially those of internal secretion, represent the end-result of decreased hypophyseal function. One photograph and a photomicrograph illustrate the article. BENJAMINR. SHORE

Case of Carcinoma of the Hypophyseal Duct, H. FUJIHIRA.Ein Fall von Hypophy- sengangskrebs, Gann 29: 325-337, 1935. A woman of thirty-one died suddenly two years after development of symptoms of dystrophia adiposogenitalis and a left serous pleuritis. Autopsy showed a grayish white tumor, 3 x 2 x 2 cm. in the brain, extending forward to the anterior commissure backward to the fossa interpeduncularis, and downward to the sella turcica. The bone tissue of the sella was greatly compressed, and at one point the tumor grew through the clivus. On frontal section of the brain through the region of the tuber cinereum the tumor was found to extend upward into the left wall of the dilated third ventricle. The tuber cinereum, corpora mammillaria, and the third ventricle were pushed upward. The left lateral ventricle was dilated. At this level there appeared a thick grayish white stripe, through the tumor, the diaphragma sellae. Histologically this tumor was a carcinoma simplex. The article is illustrated with a photograph and two photomicrographs. K. SUCIURA

Tumor of the Pineal Gland (Pinealocytoma) with Meninegal and Neural Metastases, E. D. FRIEDMANAND A. PLAUT. Arch. Neurol. & Psychiat. 33: 1324-1341, 1935. A thirty-three-year-old patient in whom the clinical diagnosis was diffuse infection of the central nervous system, probably encephalomyeloradiculitis, died with terminal bronchopneumonia. Autopsy showed a small primary tumor of the pineal gland and a diffuse metastatic involvement of the brain, cranial nerves, ganglia, spinal cord, and meninges. The primary pineal tumor was found grossly only after the diagnosis of pinealocytoma was made from the histologic appearance of the metastases. The article is well illustrated with photographs of the gross specimen and photomicrographs. BENJAMINR. SHORE

Intramedullary Spinal Cord Tumors, 0. FOERSTERAND 0. GAGEL. Klinik und Patho- histologie der intraniedulllren Ruckenmarkstumoren, Deutsche Ztschr. f. Nervenh. 136: 239-240, 1935. There were 30 extradural, 38 intradural extramedullary, and 20 intramedullary growths in a series of 88 spinal cord tumors. Of the 20 intramedullary tumors, 3 were lipomas, 1 a tuberculoma, 1 a melanoblastoma, 1 a hemangioma, 4 astrocytomas, 2 oligodendrogliomas, 1 a glioblastoma multiforme, 2 medulloblastomas, 4 ependymomas, and 1 central gliosis. Of the 20 patients, 3 died following operation, an operative mortality of 15 per cent. Six of the 17 surviving patients showed marked improvement, while the remaining 11 or 55 per cent showed no improvement. Two, or 5 per cent, of the 34 patients with extramedullary tumors died following operation. Twenty-seven, or 81 per cent, of the patients showed marked improvement, while 5, or 14 per cent, showed no improvement. Postoperative deaths occurred in 2 of the 31 patients with extradural tumors, a cure was obtained in 18, or 58 per cent, and no improvement resulted in 11, or 36 per cent. There are no illustrations. BENJAMINR. SHORE THE NERVOUS SYSTEM 64 1

Syringomyelia and Intramedullary Tumor of the Spinal Cord, R. P. MACKAYAND J. FAVILL.Arch. Neurol. & Psychiat. 33: 1255-1278, 1935. A case of syringomyelia in a woman of twenty-four with an intramedullary tumor of the spinal cord at the level of the 10th to the 12th thoracic vertebrae is reported. The patient died following laminectomy and partial removal of the growth. Histologic study of the tumor showed it to be of ependymal and glial origin, the majority of the cells being ependymal in type with rather abundant, faintly eosinophilic cytoplasm. Syringomyelia is based on a malformation of the median raphe of the medullary tube, a primary ependymal gliosis centering in this raphe and surrounding tissues of the cord, and a tendency to central degeneration of the gliosis. The glia cells of the gliosis arise from the germinal cells of the medullary epithelium, which also produce the ependyma; thus the germinal cells may give rise to an ependymal neoplasm in one portion of the cord while producing syringomyelia in another portion. The tumor and the syringomyelia are, therefore, different manifestations of the same proliferative tendency. The article is well illustrated with photomicrographs. BENJAMINR. SHORE

Tumors in the Spinal Canal in Childhood. An Analysis of the Literature with Report of a Case, W. B. HAMBY. J. Nerv. & Ment. Dis. 81: 24-42, 1935. Ninety-five verified cases of tumors of the spinal canal occurring in children under fifteen years of age have been collected from the literature and one personal case has been added. Gliomas comprise 23 per cent of the total number of cases; sarcomas, 18 per cent; neuromas, 7 per cent; meningiomas, 5 per cent. Other tumors found were dermoids, lipomas, sympathetic tissue tumors, chloromas, fibromas, hemangiomas, and several tumors in which the histologic picture was not given. Gliomas are intramedullary and occur predominantly in the cervical and upper thoracic regions. Sar- comas are usually tumors of the extradural space and occur chiefly along the dorsal cord. They are found in the very young, that is in children aged one to five years, about as frequently as in those of the older group. The neuromas and meningiomas occur characteristically in older children. The author’s patient was a ten-year-old girl from whom an ependymoma situated at the level of the 9th dorsal vertebra was partially removed surgically. Five series of roentgen-ray treatments were then given, each series consisting of five doses of 275 r each. The patient was relieved of pain and there was some improvement in the motor reflexes following these treatments. The article is illustrated with photographs, roentgenograms, photomicrographs, and drawings. BENJAMINR. SHORE

Ependymoma of the Filum Terminale, I. M. TARLOV.Arch. Neurol. & Psychiat. 32: 1045-1054, 1934. Twenty-six tumors of the filum terminale internum have been reported in the literature, of which 11 were ependymomas. A twelfth ependymoma of this region is reported in a man of fifty-four, who complained of sacral pain radiating down both extremities, of seven years’ duration, abdominal distress and constipation for one year, and mild urinary hesitancy. Neurologic examination showed slight hypalgesia, hypesthesia, and thermo- hypesthesia over the second, third, fourth and fifth sacral segments, with some hyperesthesia to all forms of sensation at the eleventh thoracic segment. 1-ipiodol injected in the 5th lumbar interspace was arrested at the second lumbar vertebra with the patient’s head down. In the upright position it descended to the second sacral vertebra. Lami- nectomy was performed and a small tumor was removed from the filum terminale. Re- covery was uneventful. The histopathology is reported in detail and photomicrographs are included. Al- though spongioblasts, astroblasts, and astrocytes were present, the predominant cell was polygonal, containing blepharoplasts and exhibiting a tendency toward ring formation. In cell type and largely in architecture, the growth resembled the central portion of the adjacent filum terminale. Because of the large amount of fat in the tumor it was mistaken grossly for a lipoma. 642 ABSTRACTS

Dermoid Tumors of the Spinal Cord. Report of Four Cases, with Observations on a Clinical Test for the Differentiation of the Source of Radicular Pains, H. C. NAFF- ZIGER AND 0. W. JONES,JR. Arch. Neurol. Sr Psychiat. 33: 941-958, 1935. The authors report the histories of four patients with cholesteatomatous tumors of the spinal cord. In each instance the lesion was situated intradurally and over the cauda equina. Special attention is called to a clinical test by which radicular pain of intradural origin may be differentiated from extradural pain of radicular type. In cases of gross space- consuming lesions within the spinal canal, radicular pain is commonly caused by tension or traction on sensory roots. In lesions of the cauda equina, pain, particularly of the bilateral sciatic type, produced by coughing, straining, sneezing, or muscular movements, has long been known to be characteristic. However, pain may be caused by the same conditions in patients with sciatica and other lesions of extradural origin. A test to differentiate these conditions consists of compression of the jugular veins, as in the Queckenstedt test; as the intracranial and intraspinal pressure above the level of a block is raised, the typical radicular pain is reproduced because the tumor or other gross lesion presumably is displaced sufficiently to cause traction on or irritation of a nerve root. The article is illustrated with drawings and photomicrographs. BENJAMINR. SHORE

Development of Metastatic Cancer in the Spine from the Radiological Point of View, F. PERUSSIA.L’evoluzione delle metastasi cancerigne del rachide nel quadro radiologico, Radiol. e fis. med. 2: 171-181, 1935. Perussia points out that metastases to the spine are difficult to demonstrate while they are still small because slight changes in the vertebrae are obscured by the surrounding soft part shadows. The earliest signs of such metastases are often slight irregularities in the outlines of the vertebrae. Compression and collapse are a later stage. When the metastasis is of the osteoplastic type, the areas of increased density in the bone coalesce to give the picture of the so-called “ ivory vertebra.” This osteoplastir type of vertebral metastasis evolves much more slowly than the osteolytic type. The paper is well illustrated by a series of 26 reproductions of roentgen films. C. D. HAAGENSEN

Papilloedema Caused by a Cervical Cord Tumour, D. MCALPINE. Lancet 2: 614-616, 1935. A woman of twenty had symptoms suggestive of a cervical cord tumor, but differing from the usual picture in that papilledema was present and there was no weakness of the upper extremities. The highest limit of sensory loss appeared to be at the level of the first dorsal segment but there was hyperesthesia as high as the 5th cervical. A laminectomy was performed and a tumor discovered, partially extramedullary but also involving the cord. This proved on biopsy to be a glioma. The papilledema subsided somewhat following operation, but death ensued within six weeks. At autopsy an elongated tumor was found extending from the 1st cervical to the 1st dorsal segment, invad- ing the cord below the level of the 3d cervical. No cerebral tumor was demonstrable. The association of papilledema with a cervical cord tumor is rare. Single cases have betw reported by Carlill and Carling (Lancet 1: 70, 1926) and Davis (Arch. Neurol. & I’sychiat. 9: 245, 1923). In these cases, as in the author’s, the tumor of the cord was a diffuse one. In 2 of the 3 cases th2 maximum growth of the tumor had not occurred at the uppermost level of the cervical cord. In all the tumor apparently tended to fill the entire subdural space at the maximum point of growth.

Tumors of the Sympathetic Nervous System, D. LEWIS. J. Tennessee M. A. 28: 47-52, 1935. This is a general discussion of tumors of the sympathetic nervous system which include neuroblastomas, paragangliomas, and gangliomas. Several case histories are included to indicate how protean the clinical manifestations of tumors arising from the sympathogonia may be and how bizarre and variable the histologic structure may be depending upon the character and degree of cellular differentiation. BENJAMINR. SHORE THE NERVOUS SYSTEM 643

Roentgen Aspects of Sympathetic Neuroblastoma, with a Report of Two Cases, A. HARTUNGAND S. R. RUBERT. Radiology 24: 607-615, 1935. Two patients, both girls five years of age, having primary sympathetic neuroblastomas arising in the cervical sympathetic trunk and diffuse metastases to the skull and long bones are described. Roentgen therapy failed to affect the tumors appreciably and produced no apparent change in the course of the disease. The article is illustrated with roentgenograms. BENJAMINR. SHORE

Neuromas, K. A. DRENNOWA.Zur Kasuistik der Neurinome, Acta oto-laryng. 23: 214-226, 1935. The histories of three patients with peripheral neuromas are reported. One tumor was situated on the occipital region of the scalp, another on the nose, and the third just lateral to the right eye. The patients in this series were twenty-five, eighteen, and nineteen years of age. It is concluded from the study of these cases that neuromas are especially frequent in young individuals with labile nervous systems and may possibly be related to changes of metabolism. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE

Peripheral Neurinomas, G. CERULLI. I neurinomi periferici e la loro diagnosi differ- enziale istologica, Pathologica 27: 19-31, 1935. The author reviews the literature particularly as to theories of histogenesis of the peripheral neurinomas. He reports two cases of neurinomas in unusual situations, one of the testicle, the other of the spermatic cord. Both were in men of the seventh decade. Both were characterized by a slow symptomless growth, sharply delimited, and by a lack of metastases. Neither affected the general well-being of the patient. In discussing the histologic diagnosis of peripheral neurinomas the author points out that the picture may be closely simulated by other fibrillar neoplasms, but that differential staining distinguishes the blastomas of connective tissue origin. He gives the technic of the Jeddeloh color reaction (Centralbl. f. allg. Path. u. path. Anat. 49: 193, 1930), which may be used to distinguish the neurinoma from the benign leiomyomas of similar morphology. The article is illustrated by photomicrographs, and a long bibliography is appended. JEANNETTE MUNRO

Neurofibroma of von Recklinghausen ; Large Mammary Tumor With Numerous Small Disseminated Lesions, H. GOUGEROT,J. MEYER AND W. STEWART.Neuro- fibromatose de Recklinghausen; tumeur royale mammaire Cnorrne et petites ICsions dissCminCes tres nombreuses, Bull. SOC.frans. dermat. et syph. 42: 429-431, 1935. This patient had a tumor 20 x 30 cm. in extent and raised 5 mm. above the surface occupying nearly the whole left breast. Its consistency was firm, its surface wrinkled, and its color brown. Scattered over the entire body were many small cafe au lait spots, and along the course of the left internal brachial cutaneous nerve were six small nodules. A biopsy report is given on a section of the breast tumor, confirming the diagnosis of neurofibroma. A short bibliography of M. Gougerot’s other publications on von Recklinghausen’s disease is appended. There are no illustrations. THEODOREP. EBERHARD

Familial v. Recklinghausen’s Disease Coexistent with Paget’s Disease in the Father, H. GOUGEROTAND P. BURNIER. Maladie de Recklinghausen familiale coexistence de maladie osseuse de Paget chez le phre, Arch. dermat.-syph. 7: 220-225, 1935. A father of four children had neurofibromas of the v. Recklinghausen type. At sixty-three he developed Paget’s disease. Two of the children had brown pigmented nevi of the thorax; the other two were not examined. Roentgenograms demonstrate the lesions of Paget’s disease, but there is no record of biopsy in any of the cases. No bibliography is appended. CHARLESA. WALTMAN 644 ABSTRACTS

Neurofibromatosis with a Large Tumor of the Cheek, H. GOUGEROTAND P. BLUM. Neurofibromatose de Recklinghausen avec tumeur royale de la joue, Arch. dermat.- syph. 7: 226-227, 1935. A case of multiple skin tumors was diagnosed clinically as v. Recklinghausen's neurofibromatosis. One of the tumors, on the cheek, measured 7 x 5 cm. There was no familial history of this disease, and there is no record of biopsy being done. CHARLES A. WALTMAN

THE BONES, JOINTS, AND TENDON SHEATHS

Tumors of the Sacrum from the Radiological Point of View, C. PICCHIO. I tumori del sacro dal punto di vista radiologico, Radiol. med. 22: 737-767, 1935. Picchio describes four primary tumors of the sacral region, laying special emphasis upon the radiological findings, which he illustrates with a series of 24 reproductions of roentgen films. The first case was a chordoma of the sacral region occurring in a child aged eight years. During the year that it had been present it had grown rapidly and two attempts at operative removal had failed to check it. It was therefore given 3,000 Y units of roentgen treatment over a period of twenty days [the details of the treatment are not stated]. " Several months later " there had been no further progress of the disease. The second patient was a man of twenty-five with an osteogenic sarcoma arising in the left half of the sacrum. He was given 4500 r units of roentgen treatment through three ports over a period of forty-five days [details are not stated]. This therapy relieved his pain, and he was able to use his left leg again. Three months later, however, pulmonary metastases developed. The third patient was a youth aged fifteen with a large tumor arising from the sacrum and projecting into the pelvis, compressing the ureters and causing pyonephrosis. This complication caused death after nine months. Autopsy showed the tumor to be a chondroma with sarcomatous areas. There were no metastases. In the fourth case, that of a man aged fifty, there was destruction of a large portion of the left half of the sacrum. A biopsy showed adenocarcinoma. Roentgen treatment relieved pain until death, four years later. An incomplete autopsy failed to reveal the primary site of the carcinoma. C. D. HAAGENSEN

Myelomas, P. LOMBARDAND LE GENISSEL. MyClomes, Algerie mCd. 39: 439-451, 1935. After a general review of myelomas the authors report four cases. (1) A child of five had a tumor of the maxillary region, shown by biopsy to be a lymphocytoma. The patient died. (2) Biopsy of the ilium in an eight-year-old boy yielded tissue of a myelomatous aspect. No other bones were involved. Death was due to metastases in the lungs. Autopsy was not obtained. (3) A thirteen-year-old girl had a tumor of the fibula that was diagnosed as myeloma by aspiration biopsy. Two x-ray photographs show the appearance of the tumor. No autopsy is reported. (4) A child of twenty months had a tumor of the nasal bone with extensive involvement of the cervical nodes. A biopsy of the nasal tumor showed complete degeneration. The biopsy of a lymph node showed a myeloblastic type of leukemia. There is no autopsy report. CHARLES A. WALTMAN

Differential Diagnosis of Generalized Osteolytic Carcinomatous Metastases and Multiple Myelomas, T. CANIGIANI.Zur Differentialdiagnose der universellen osteolytischen Karzinommetastasen und des multiplen Myeloms, Fortschr. a.d. Geb. d. Rontgenstrahlen 52: 386-400, 1935. The differential diagnosis between osteolytic carcinomas and multiple myelomas roentgenographically is at times difficult and may be impossible. The ordinary sites of origin for these growths are the breast, lung, and adrenal gland; more rarely the thyroid THE BONES, JOINTS, AND TENDON SHEATHS 645 gland may harbor the primary growth. The histories of four cases of generalized osteolytic metastatic carcinoma and five of multiple myeloma are included, with roentgenograms. BENJAMINR. SHORE

Four Cases of Ewing Sarcoma in Ribs, H. BERGSTRAND.Am. J. Cancer 27: 26-36, 1936. Four cases of Ewing sarcoma of the ribs are reported, all occurring in boys just reaching puberty and all arising in the posterior part of one of the ribs, and showing a sponge-like growth into the pleural cavity. Bergstrand believes that practically all Ewing sarcomas are localized in those parts of the skeleton in which ossification begins in the second month of fetal life and that they may be due to a disturbance in the formation of the skeleton at an early stage. The paper is illustrated by roentgenograms and photomicrographs. A brief bibliography is appended. [See also Herbert’s report, abstracted below.]

Ewing’s Tumor of the Rib, Report of Two Cases, W. P. HERBERT. J. Thoracic Surg. 5: 189-194, 1935. The author reports two patients with Ewing’s tumor of the rib. The first was a ten-year-old boy who had received a relatively slight trauma to the left side of the chest in the early part of May 1933. Early in June a pleural effusion developed and in August a diagnosis of Ewing’s sarcoma of the sixth rib was made from roentgenograms and histologic study of the resected specimen. The patient was given deep roentgen ray therapy but died in September 1933. The second patient was a twenty-year-old man with a history of trauma of unknown extent to his left side six and one-half years before the development of the tumor. A severe cough, fever, loss of weight, and a tumor situated over the third rib in the left axilla were the presenting symptoms. The diagnosis of a Ewing’s sarcoma was made from roentgenograms and histologic study of the excised rib. The patient received deep roentgen therapy with beneficial results so far as the residual tumor was concerned but without noticeable effect on the general condition. The article is not illustrated. [Compare Bergstrand’s cases, abstracted above.] BENJAMINR. SHORE

Contribution to the Pathology of Endothelioma in the Temporal Bone, Y. MEURMAN. Acta oto-laryng. 22: 455-467, 1935. A twenty-seven-year-old woman died six years after the onset of symptoms due to a meningioma at the base of the brain. At autopsy the growth was found attached to the left petrosal bone and in close proximity to the oculomotor nerve. There had been marked erosion of the bone and infiltration of the middle ear by tumor. In spite of the fact that the inner ear was completely surrounded by tumor, the special sensitive end- organs remained intact; the shutting off of the internal auditory canal and the cochlear aqueduct did not interfere with the perilymph production. The article is illustrated with photomicrographs. BENJAMINR. SHORE

Osteosarcoma Developing in the Presence of Paget’s Disease, G. JEANNENEY AND A. LAPORTE. OstCosarcome au cours d’une maladie osseuse de Paget, Gaz. hebd. sc. mCd. de Bordeaux 56: 553-556, 1935. A patient with Paget’s disease suffered a pathological fracture of the humerus. Roentgen examination at the time showed no tumor, but evidences of Paget’s disease were demonstrable. Twenty-eight days after the initial injury a malignant tumor was diagnosed roentgenographically and the arm was amputated at the shoulder. Patho- logically an invasive bone tumor was described. No follow-up is given. Two roentgenograms are reproduced and there is a review of the literature. [Sarcoma ultimately occurs in some 10 per cent of persons with Paget’s disease. See for discussion of this fact an excellent paper by C. E. Bird: Sarcoma in Paget’s Disease, Arch. Surg. 14: 1187-1208, 1927.1 CHARLESA. WALTMAN 646 ABSTRACTS

Liposarcoma of Bone. Report of Two Cases and Review of Literature, D. J. REHBOCK AND H. HAUSER. Am. J. Cancer 27: 37-44, 1936. Two autopsied cases of liposarcoma of the bone are reported and the 5 other cases from the literature are tabulated. In one of the authors’ cases there were widespread metastases, especially in the lymph nodes and bone. In the other no metastases were found. Both showed, histologically, tumor cells resembling embryonic fat cells with fat droplets in the cytoplasm. References to the reported cases are appended. Roent- genograms and photomicrographs illustrate the report.

Present Conception of the Traumatic Origin of Sarcomas in Osteitis Fibrosa, I.. PICK. Die jetzigen Anschauungen uber die traumatische Entstehung von Sarkomen bei der sog. fibrosen Ostitis, Monatschr. f. Unfallh. 42: 239-242, 1935. This is a general discussion of the relation of trauma to the development of malignant. tumors in cases of von Recklinghausen’s and Paget’s disease. In von Recklinghausen’s disease the subsequent development of a sarcoma due to trauma has never been reported, while in Paget’s disease, although secondary malignant tumors are occasionally seen, the relation between trauma and the development of these growths lacks definite proof. From a rather large experience, Pick treats with skepticism the traumatic origin of sarcomas, except such as develop in sinuses, calluses, and similar lesions following injury. BENJAMINR. SHORE

Giant-cell Tumor, ROUYER,MONTPELLIER AND JACQUEMIN. Un cas de tumeur du squelette A cellules &antes (tumeur A mykloplaxes) d’aspect sarcomatoide, Algerie inbd. 39: 820-822, 1935. This is a report of a tumor of the distal end of the radius. There was ulceration of the skin and x-ray showed some bone proliferation in the depths suggesting sarcoma. Iiistologically, the neoplasm was a giant-cell tumor with a central osteoma. A gross photograph of the tumor and a roentgenogram are included. There is no bibliography. CHARLESA. WALTMAN

Invasion of Joints by Malignant Tumors. Metastases to Joints, J. SABRAZBSAND K. I)E GRAILLY. Tumeurs articulaires malignes de propagation. Tumeurs articulaires malignes mktastatiques, Gaz. hebd. d. sc. med. de Bordeaux 56: 115-121, 1935. The author has collected from the literature several cases in which there was direct invasion of joints by nearby tumors or metastases to joints from more remote tumors. No new cases are reported, and there is no bibliography. The paper is unillustrated. CHARLESA. WALTMAN

Disarticulation of the Hip, F. FERRARI.La desarticulation de la hanche pour tumeurs malignes du membre infkrieur, Algerie mkd. 39: 416-421, 1935. A technic for disarticulation of the hip is described. It was applied in two patients, one of whom died following the operation; the other was in good health twenty months later. Seven diagrams illustrate the procedure. CHARLESA. WALTMAN

Synoviomas of the Tendon Sheaths and Bursae, PAULZWAHLEN. Sur les synoviomes des gaines tendineuses et des bourses skreuses, Bull. Assoc. franG. p. I’btude du cancer 24: 682-707, 1935. In addition to the ordinary connective tissue growth the tendon sheaths and serous bursae give rise to two special types of neoplasm. These are: (1) The xanthomatous tumor with giant cells. Its neoplastic nature, long a matter of discussion, appears now to have been definitely established. It frequently recurs after excision, but never metastasizes. (2) The synovioma, which contains no xanthoma cells, and giant cells but rarely. It may, however, be sown through with mast cells. It is composed of sarcomatous portions mingled with cells that resemble epithelium in forming glandular structures, and LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOSARCOMA 647

synovial spaces and papillary outgrowths are a conspicuous feature. The synovioma grows slowly but usually recurs after extirpation and generally terminates in metastasis and death. Two growths of the latter type are described, one involving the forearm of a twenty- two-year-old female and the other the foot of a sixteen-year-old boy. This excellent paper is illustrated by photomicrographs and photographs of gross specimens and includes a useful bibliography. A good paper on this subject is that of I,. W. Smith: Am. J. Path. 3: 355, 1927. WM. H. WOGLOM

THE LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOSARCOMA, RETICULO-ENDOTHELIOSIS

The Heterophil Antibody Test in Leukemia and Leukemoid Conditions, GEORGEL. WEINSTEINAND THOMASFITZ-HUGH, JR. Am. J. M. Sc. 190: 106-112, 1935. The heterophil antibody titre in serum from 16 cases of leukemia (acute or chronic lymphatic or myelogenous) was uniformly low, an observation which confirms previous investigation and which may be of value in eliminating the diagnosis of leukemia when the titre is high. Low or normal values were found, also, in a number of other conditions, including Hodgkin’s disease, lymphosarcoma, simple adenitis, etc. The parenteral administration of horse serum did not produce a rise of the heterophil antibody titre in 5 patients with chronic lymphatic leukemia. This finding also is in accord with previous evidence. A similar failure to rise after the introduction of horse serum was found in one instance of ‘‘ atypical ” Hodgkin’s disease and 2 of lymphosarcoma, suggesting the possibility of a biologic relationship between these diseases and lymphatic leukemia. The parenteral administration of horse serum to 3 patients with chronic myelogenous leukemia caused a distinct increase in titre. This finding, which is not in accord with previous evidence, suggests the possibility of a real biologic difference between myelogenous leukemia on the one hand and the lymphatic group on the other. wM. H. WOGLOM

Splenic Puncture in the Etiological Study of the Leukaemias, C. PAPAFOTIS.La ponction de la rate et son importance pour I’Ctude Ctiologique des IeucCmies, Bull. mCd., Paris 49: 399-402, 1935. The author states that all authorities agree that the leukemias are infectious diseases, but we have not found the mysterious germ that causes them. He reviews the literature and briefly describes his negative results from injection of a guinea-pig with material obtained from the spleen of a patient with chronic myelogenous leukemia. A bibliography is appended. CHARLESA. WALTMAN

Monocytic (Histiocytic) Leukaemia, T. N. GLEDHILL.Lancet 2 : 824-825, 1935. The author presents a case in a man of forty-eight with a blood picture typical of monocytic leukemia. The patient was eventually lost sight of, the last blood count being: red cells 3,150,000; white cells 24,000 with polymorphonuclears 24 per cent, lymphocytes 22 per cent, monocytes 54 per cent. Tooth extraction and antisyphilitic measures are the only therapy mentioned. Blood films are reproduced.

Behavior of the Cells of the Red Series in the Blood and in the Hematopoietic Organs in Erythroleukemia, M. RUFANO. Sul comportamento delle cellule della serie rossa nel sangue e negli organi ematopoietici nelle eritro-leucemie, Pathologica 27: 31 1-321, 1935. Two patients with somewhat similar blood findings-hypochromic anemia with megaloblastosis, erythroblastosis, and leukopenia with myeloblasts-are described. In the spleen and bone marrow erythroblastic and megaloblastic hyperplasia was evident 648 ABSTRACTS together with hyperplasia of the granulocytogenic elements. Both patients showed complete gastric achlorhydria and both improved under liver treatment. These alterations are believed to be due to the fact that the cells no longer derive, as normally, from the hemocytoblasts, but pathologically from the histocytes of the hematopoietic organs. Bufano discusses the possible relationships between the in- sufficiency of the endocrine secretion of the gastric mucosa and the development of these forms of erythroleukemia. The article is illustrated by photomicrographs. JEANNETTE MUNRO

Lymphogranulomatosis and Reticulo-endotheliosis, CARL STERNBERG.Lympho- granulomatose und Reticulo-endotheliose, Ergebn. d. allg. Path. u. path. Anat. 30: 1-76, 1936. The lamented death of the late Professor Sternberg has removed one of the masters of pathology, especially of the lymphatic structures, but before his death he was able to finish this survey. Lkspite the enormous amount of work which has been done on lymphogranulomatosis, or Hodgkin’s disease as it is commonly designated, we are still quite in the dark as to its etiology. Most authors still consider the disease as related to tuberculosis, while a minority regard the process as one of the forms of lymphoblastoma. An interesting recent observation quoted by Sternberg is that of a child of three and a half months who had extensive Hodgkin’s lesions and whose mother died of the same disease a few months after the child’s birth. This argues more for an infectious origin than for a neoplastic nature. A most instructive part of this review is that on the atypical forms. The section devoted to reticulo-endotheliosis is short. Since our knowledge of the condition is still imperfect, and the disease is less frequent than, for example, Hodgkin’s, we are still in the stage of individual case reports, and many recent ones are quoted by Sternberg. The usual extensive bibliography heads the article, and a number of photomicrographs of interesting types of lesions are well reproduced.

Unusual Case of Lymphogranulomatosis of the Femur, R. BAUMANN-SCHENKER.Ober einen ungewohnlichen Fall von Knochenlymphogranulomatose des Femur (Kurze kasuistiche Mitteilung), Rontgenpraxis 7: 760-762, 1935. The author reports the case of a twenty-eight-year-old man with Hodgkin’s disease of the cervical, thoracic, and inguinal lymph nodes and lymphogranulomatous tumors of the left femur and left ilium. Roentgenologically the lesion in the femur was characterized by an unusually extensive area of periosteal thickening, 12.5 cm. long and 3.5 cm. wide, which overlay thickened cortex. The lesion in the ilium showed the ordinary osteoplastic characteristics without the periosteal thickening. The lesion in the femur in this case was considered to be hematogenous in origin. Three roentgenograms illustrate the article. BENJAMINR. SHORE

Hodgkin’s Disease in Natives of Nigeria, E. C. SMITH. Lancet 2: 874-877, 1935. Eight examples of lymphadenoma and one possible case are reported from Lagos, Nigeria. In 6 of these the diagnosis was based upon histological findings alone; in 3 the biological test described by Gordon (in Rose Research on Lymphadenoma, John Wright NC Sons, Rristol, 1932) was carried out in addition. The test was definitely positive in 2 of the cases. The third case was not typical histologically and must be regarded as doubtful. Material from 4 of the cases under review was investigated for the presence of diphtheroid bacilli, and the organism was isolated in all. Cultures of one strain of the organism were used for animal inoculations with negative results. Photomicrographs are included. LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOSARCOMA 649

Lymphosarcoma Developing in a Patient Previously Having Multiple Lymphoid Nodules of the Skin Resembling Sarcoid, L. M. PAUTRIERAND FR. WORINGER.Lympho- sarcome dbveloppe chez un malade present6 antbrieurement pour lbsions dermo- hypodermiques dissCminCes ressemblant cliniquement A des sarcoides hypodermiques et constitubes histologiquement par des Clbments de la lignCe lymphoblastique, Bull. SOC.fraq. dermat. et syph. 42: 836-841, 1935. A young man in the twenties had multiple tumors of the skin which were clinically thought to be a Darier-Roussy sarcoid. Two biopsies were taken, one from the abdominal wall and one from the hip, which showed diffuse and circumscribed collections of lymphoblasts. A provisional diagnosis of aleukemic leukemia was made, although the lymph nodes were not enlarged nor was the spleen palpable. [At this stage the case was reported in Bull. SOC.franc. dermat. et syph. 41: 1459, 1934. Abst. in Am. J. Cancer 24: 164, 1935.1 All involved areas except that surrounding the excised abdominal lesion were irradiated, receiving a dose of about 900 r. The patient did not return for nine months. It was then found that all of the irradiated lesions had disappeared but there was a recurrence on the abdominal wall at the site of the excised mass. There were also new lesions on the trunk and limbs. On biopsy these showed essentially the same structure as the earlier lesions, with the addition of many mitoses, by virtue of which the authors now make the diagnosis of lymphosarcoma. Three gross photographs but no photomicrographs are inrluded. THEODOREP. EBERHARD

Erosion of Vertebrae by Para-Osteal Tumors, C. PICCHIO.Usure vertebrali da tumori paraostali, Radiol. e fis. med. 11, n.s. 2: 40-44, 1935. Two cases are described and illustrated by reproductions of the roentgen films in which lymphosarcomatous masses, situated in the mediastinum adjacent to the vertebrae, appeared to erode and invade them. Unfortunately, the autopsy findings are not available. C. D. HAAGENSEN

Autopsied Case .of So-called Reticulo-endotheliosis (Reticulomatosis of Ogata), T. YOSHIDA. Uber einen Sektionsfall der sog. Reticuloendotheliosis (Reticulomatosis- Ogata), Gann 30: 132-141, 1936. A man of twenty had generalized enlargement of the lymph nodes and of the spleen and liver, present for about five months. The patient’s attention had first been attracted to the nodes in the groin, and subsequently others had appeared elsewhere in the body. Leukopenia was present, and in the later stages the leukocyte count fell to 2200 without definite change in the differential count. Roentgen treatment brought about some regression of the nodes but clinically the patient failed to improve and death ensued from pneumonia. Post-mortem examination showed enlargement of the lymph nodes and of the spleen, which weighed 1295 gm. and contained numerous white nodules. The liver weighed 2895 gm. As a result of histologic examination, the changes in the lymph nodes, liver, spleen and other organs were attributed to a systemic tumor-like proliferation of the reticular-cell system. The proliferating cells had definite star-shaped protoplasmic processes, by which they were united in the form of a net. The article is illustrated by four photomicrographs. K. SUGIURA

Radiation Therapy in Medical Practice. IV. Leukemia, Hodgkin’s Granuloma and Allied Diseases, E. A. POHLE. Wisconsin M. J. 34: 632-636, 1935. A report of a case of Mikulicz’s disease treated successfully by radiotherapy is included with others in this article. There are photographs of this patient, showing him before and after treatment. A short bibliography is appended. CHARLESA. WALTMAN 650 ABSTRACTS

EDUCATION

Organization of a Cancer Campaign, ARTHURHINTZE. Die Organisation der Krebs- bekgmpfung, Deutsche med. Wchnschr. 61 : 1390-1392, 1935. The specialist, the general practitioner, the public, and the person with cancer all view malignant disease in a different way. The great difficulty for the specialist is usually not diagnosis, but treatment. As this may be either surgery or radiology, and no man can encompass both, the problem here is evidently one of cooperation between specialists. As for the general practitioner it is usually not essential, and sometimes it is impossible, for him to make a definite diagnosis of cancer. It is enough if only he will suspect. There need be no fear that the modern practitioner will overwhelm the special institu- tions with patients who prove finally not to have malignant disease, but he should not be blamed if only one out of two or three of the patients whom he refers turns out to have cancer. On the contrary, this is an ideal which has not yet been attained, for the diagnosis can usually be made as the patient enters the door. He comes with all the signs that are demonstrated in medical schools as characteristic, and the patient who is sent in for examination because of a mere suspicion is rare indeed. Yet it is this one, first suspected and then by all the resources of a great institute actually proved to have cancer, who should be shown to the student. The question whether the general practitioner himself can cure cancer without the aid of surgery or radiotherapy must be answered with an emphatic negative. The attempt has been made a thousand times and decrease in the size of the tumor, improvement in the general condition, gain in weight, and so on, have all been reported- temporary improvements, however, that often occur spontaneously during the long course of malignant disease. But there have been no cures by medical treatment; no, not even a prolongation of life. The general public may be advised and instructed with great benefit, but the ultimate success of all cancer campaigns stands or falls with its faith in the family physician. To him the first appeal is made and his is the duty of directing the patient to that source whence help may be best obtained. The first concern of all organization should be, accordingly, to promulgate cooperation between family physician and specialist, for unless this be done all direct approach to the public or even to the cancer patient himself will be in vain. WM. H. WOGLOM

Unsolved Problems of Oncology, NEWIADOMSKI.Les problemes non rCsolus de I'oncologie, NCoplasmes 14: 139-146, 1935. The hypothesis that cancer is caused by a virus solves many of the most difficult problems in oncology. WM. H. WOGLOM

Publications from the Institute of Cancer of Paris, G. Rouss~. Travaux de I'Institute du cancer de la FacultC de mCdecine de Paris, Gaz. hebd. d. sc. mCd. Bordeaux 56: 209-211, 1935. A bibliography of the members of the Institute. CHARLESA. WALTMAN

STAT1STI CS

Malignant Disease in the Natives of Kenya, F. W. VINT. Lancet 2: 628-630, 1935. Vint examined 2378 tissues from natives of Kenya, on the east coast of Africa, and in 546 or 23 per cent discovered malignant change. The types of tumor were as follows: carcinoma 277 cases (50.7 per cent), sarcoma 178 (34.4 per cent), melanoma 59 (10.8 per cent), endothelioma 15 (2.7 per cent), teratoblastoma 14 (2.5 per cent), chorionepithelioma 2 (0.3 per cent), hypernephroma 1 (0.1 per cent). Malignant growths of the skin are of the utmost importance in the East African native, accounting for 36.4 per cent of the total. Only 2 basal-cell cancers were seen. The large number of squamous-cell cancers is due to the prevalence of malignant change STATISTICS 65 1 in tropical ulcers of the leg. Of a routine series of 282 such ulcers, 2 per cent were found to be malignant. There were 25 carcinomata and 4 sarcomatous growths of the breast, 5.3 of the entire series. Five of the carcinomata and 2 of the sarcomata were in males. Fifteen cancers of the male genital organs were seen, including 9 epitheliomata of the penis, all from uncircumcised natives (in most of the tribes circumcision is practised). Thirteen cancers of the female genital tract were seen. Only 1 carcinoma of the body of the uterus and 1 uterine sarcoma were observed, epitheliomata accounting for the majority of growths of the female genitals. The incidence of liver tumors was high, as in most African statistics; of the 37 cases seen, 31 were liver-cell growths and 7 of bile-duct origin. Cirrhosis was usually present in these cases. Gastro-intestinal cancer was not common. The author points out that while this series may be considered, representative of the native population of Kenya, it accounts for only a small proportion of the tumors found throughout the colony. Figures for age incidence are unreliable; the maximum would seem to fall in the decade thirty to forty. [This report, like others from African laboratories and hospitals, bears evidence to the fallacy of the theory that cancer is rare among primitive peoples. See Berman: South African J. M. Sc. 1: 12, 1935. (Abst. in Am, J. Cancer 27: 214, 1936), Smith and Elmes: Ann. Trop. Med. 28: 461, 1934 (Abst. in Am. J. Cancer 27: 418, 1936), and Horgan: Lancet 2: 156, 1935 (Abst. above, p. 590).